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ABI lured thousands of New Yorkers, stole $5m from Medicaid

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Staff writer |
ABI
Empire State   Unnecessary medical tests and expenses

New York Attorney General Eric T. Schneiderman announced the arrest of Joseph Wright of Middletown NY, for allegedly stealing over $5 million from Medicaid.

Prosecutors allege that Wright, as owner of a purportedly not-for-profit organization “Assistance By Improv II, Inc.” (ABI), located at 953 Southern Boulevard in the Bronx, lured thousands of low-income New Yorkers to ABI with the promise of affordable housing, arranged to have them subjected to unnecessary medical tests and then filed false claims for reimbursement with the State Medicaid program.

Prosecutors alleged in papers filed in court that Wright unlawfully owns and operates ABI as a medical mill that masquerades as a charitable housing organization.

ABI claims in newspapers, on television and on city bus advertisements to be dedicated to providing affordable housing for developmental disabled New Yorkers.

Prosecutors allege that Wright ignored ABI’s professed charitable mission and duped potential clients, most of whom were Medicaid recipients, into surrendering their personal health care information and undergoing purported medical screening to qualify for housing.

Prosecutors allege that potential clients were directed to see various doctors and counselors at ABI, and were often subjected to unnecessary purported medical tests and procedures.

Thereafter, staff at ABI under the direction of Wright, and at the behest of various doctors and counselors employed by ABI, submitted false claims for reimbursement to Medicaid for services allegedly rendered to the Medicaid recipients who provided Wright, his staff and ABI with their client identification numbers.

Wright, prosecutors allege, used the doctors’ and patients’ Medicaid identification numbers to submit a staggering volume of claims for services allegedly rendered to Medicaid recipients.

In an eight-month span, eight Medicaid providers employed by Wright and ABI submitted over 125,000 claims for medical services allegedly rendered to Medicaid recipients.

The value of these claims totaled in excess of $1o million dollars, for which Medicaid reimbursed these eight doctors over $5 million dollars, and they in turn paid Wright millions of dollars.

Prosecutors allege that Medicaid paid these claims based upon each doctor’s representation as to the accuracy and veracity of each claim submitted.

An overwhelming number of these claims though were for treatment in connection with a primary diagnosis of “counseling and advice on contraception” or “other contraceptive/sex counseling” and bore no resemblance to the purported treatment actually provided, if any. Often these claims were completely fictitious and factually impossible.

According to claims records maintained by the Medicaid program, prosecutors allege, these doctors saw hundreds of patients a day and each patient received the same medical diagnosis.

Many of the doctors practiced outside their field of specialty according to their claims data and the claimed medical diagnosis and treatment was often one each doctor was unqualified to give.

Furthermore, given the number of claims filed each day by each doctor, the doctors could not have physically rendered the treatment they claimed to have provided.

To date, the Attorney General’s investigation uncovered no evidence that any of ABI’s patients ever received any housing despite being subjected to unnecessary medical examinations, medical tests, and multiple visits to ABI.


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