NEWS RELEASE
UNITED STATES ATTORNEY'S OFFICE
WESTERN DISTRICT OF VIRGINIA
John L. Brownlee United States Attorney Heidi Coy Public Affairs Specialist |
BB&T Building 310 1st Street, S.W., Room 906 Roanoke, Virginia 24011 (540) 857-2250 FAX (540) 857-2180 |
October 27, 2006
LEE COUNTY DENTIST INDICTED ON CHARGES OF RACKETEERING, HEALTHCARE FRAUD, MAIL FRAUD, WIRE FRAUD, AND MONEY LAUNDERING
United States Attorney John L. Brownlee and Virginia Attorney General Bob McDonnell announced today that Roy Silas Shelburne, age 51, of Pennington Gap, Virginia, was indicted by a federal Grand Jury sitting in Abingdon, Virginia.
Shelburne was charged in an eight count indictment with racketeering, healthcare fraud, mail fraud, wire fraud, money laundering, and interstate transportation of monies taken by fraud after a joint investigation by the Virginia Attorney General’s Medicaid Fraud Control Unit, the Internal Revenue Service, and the United States Attorney’s Office.
“The Grand Jury has charged that Roy Shelburne was lining his own pockets by over billing Medicaid. Time after time, Medicaid was billed for services not performed, or services that were not needed,” said United States Attorney John Brownlee. “Shelburne gave no thought to the needs or the quality of care provided to his patients. In some cases, the work that was done was performed in such a manner that it was the equivalent of having no dental services performed at all.”
“We are committed to stopping Medicaid fraud in the state of Virginia. Roy Shelburne was engaged in a continuing scheme where he was preying upon children and low income families. In the process he was taking thousands of dollars from Medicaid,” said Virginia Attorney General Bob McDonnell.
According to the indictment, Shelburne was a licensed dentist with a practice in Pennington Gap, Virginia. Beginning in July 1998, Shelburne became a Medicaid service provider. Shelburne devised a scheme to maximize the income from his dental practice by over billing insurance carriers and Medicaid for services that were not necessary or that were never performed. Shelburne would also direct his employees to bill for activities that were never performed or that were medically unnecessary. The false and fraudulent billings related primarily to low income patients and under age patients including, but not limited to, juveniles who were residents of the Harvest Child Care Ministries group home.
The Grand Jury has charged that Shelburne would “upcode” certain patient bills, meaning he would perform one procedure but bill for a procedure that provides a higher payment from Medicaid. Shelburne would also submit billings for services which were incomplete, medically unnecessary, and which were in many cases detrimental to the health of the patient. Shelburne submitted billing for services which were performed in such a manner as to be the medical equivalent of no services having been provided at all. These billings were often inaccurate and not supported by documentation in the patient files. Shelburne would also bill both Medicaid and private health insurance companies for services rendered in connection with a single procedure, collect money from both agencies, and then would not reimburse either Medicaid or the private health insurance company for fees collected.
According to the indictment, Shelburne submitted at least 135 false or fraudulent billing statements by mail and submitted 8 false or fraudulent billings electronically.
After receiving these funds, Shelburne would deposit monies into a retirement account in North Carolina. Shelburne deposited $46,200 in 2004, $40,800 in 2003, and $39,000 in 2002. Shelburne would also use these monies in order to fund a new home for himself and his family.
“Typical healthcare fraud investigations are lengthy, labor intensive, and involve complex issues. IRS Criminal Investigation participates on multi-agency task forces and works closely with federal, state, and local agencies. These task forces, in coordination with the United States Attorney’s Office, capitalize on the strengths and expertise of the participating agencies to effectively deal with healthcare fraud,” said Charles Pine, Special Agent in Charge for the IRS.
If convicted on all counts, the maximum penalty faced by the defendant is 120 years imprisonment and/or a fine of $1,250,000.
The investigation of the case was conducted by the Internal Revenue Service and the Office of the Attorney General, Commonwealth of Virginia, Medicaid Fraud Control Unit. Assistant United States Attorney Anthony P. Giorno will prosecute the case.
A Grand Jury indictment is only a charge and not evidence of guilt. The defendant is entitled to a fair trial with the burden on the government to prove guilt beyond a reasonable doubt.