FRANKFORT, Ky. (Aug. 16, 2016) – Attorney General Andy Beshear and his Office of Medicaid Fraud and Abuse today announced the indictment of a Lawrence County Medical Practice and the arrest of three providers of the practice on charges related to Medicaid fraud and forgery of prescriptions, both Class D felonies.
Tri-State Family Medical Center LLC, Dr. Alfred Baldera, 63, Kevin Gauze, 47, and Janice Gauze, 47, were indicted by a Lawrence County grand jury Friday, Aug. 12. The three were subsequently arrested on that indictment.
Baldera faces up to 20 years for four Class D felonies including two counts of Medicaid Fraud; one count of forgery of a prescription; and two counts related to unlawful prescribing of controlled substances.
Kevin Gauze faces up to 20 years for five Class D felonies including two counts of Medicaid Fraud; one count of forgery of a prescription; two counts related to unlawful prescribing of controlled substances; and one count related to unauthorized procurement of controlled substances.
Janice Gauze faces up to five years for one Class D felony related to unauthorized procurement of controlled substances.
In addition, Tri-State Family Medical Center LLC faces up to $20,000 in fines for two counts of Medicaid fraud and one count of forgery of a prescription.
“My office will pursue any and every provider who attempts to steal from the Medicaid Program,” Beshear said. “Medicaid is a vital service that our state can afford and must support. My office is committed to protecting Kentucky families and seniors from anyone who would defraud such a critical program.”
It is alleged that between 2010 and 2013, Kevin Gauze and Alfred Baldera fraudulently billed Medicaid for office visits and drug testing where the patients were not present. This resulted in a substantial loss to the Medicaid program.
It is also alleged that during 2016, Kevin Gauze and Baldera fraudulently billed Medicaid for services utilizing Baldera as a performing provider when Baldera was not present to perform the services.
Additionally, it is alleged that Baldera and Kevin Gauze engaged in forging prescription for controlled substances when Gauze forged Baldera’s name to Medicaid and non-Medicaid patients’ prescriptions when Baldera did not provide the services.
Additionally, it is alleged that Kevin Gauze forged Baldera’s signature on prescriptions for controlled substances for himself.
Also, it is alleged that Janice Gauze presented prescriptions for controlled substances which were not authorized by law.
Their arraignment has not been scheduled by the Lawrence Circuit Court.
This case was investigated by Office of Medicaid Fraud and Abuse of the Kentucky Attorney General’s Office with vital assistance from the Appalachia HIDTA Diversion Task Force and the Cabinet for Health and Family Service’s Office of the Inspector General, Drug Enforcement and Professional Practices Branch.
A charge is merely an accusation. A defendant is presumed innocent until and unless proven guilty.
The Attorney General’s tip line for reporting allegations of Medicaid provider fraud is 502-696-5405. Since taking office in January, Attorney General Andy Beshear has recovered more than $8.5 million for the state through Medicaid Provider Fraud recoveries.
SOURCE: Kentucky Attorney General’s Office