Ex-doctor from Kokomo accused of Medicaid fraud reaches settlement

KOKOMO, Ind. (WISH) — A former doctor from Kokomo accused of Medicaid fraud has reached a settlement with the U.S. Attorney’s Office based in Hammond.

U.S. Attorney Adam L. Mildred said in a news release issued Wednesday afternoon that a settlement of nearly $1.7 million was reached in the case involving former physician Don J. Wagoner, 89, and his limited liability corporation, now-closed Wagoner Medical Center, for fraudulently billing the Indiana Medicaid program.

Prosecutors said the fraudulent scheme involved more than 5,000 claims submitted by Wagoner during his practice at the center from 2011 to 2013.

An investigation found that Wagoner required patients to undergo urine tests but falsely claimed more extensive and costly testing. Indiana Medicaid allows for $20.83 to be billed for such tests, but Wagoner received $171.27 or more per test, resulting in nearly $1 million in overpayments.

Medicaid is a joint federal and state program that provides free or low-cost health coverage to eligible low-income people, families and children, pregnant women, the elderly, and people with disabilities.

According to court documents, Wagoner routinely collected only a single urine sample from patients seeking prescriptions for opioids and other pain medication, despite certifying to the Medicaid program that he’d conducted nine or more sample analyses per patient. The practice led ...