Health district employees charged with Medicaid fraud, filing more than 1,300 false claims

5th District Court, St. George, Utah, Dec. 15, 2015 | Photo by Mori Kessler, St. George News

ST. GEORGE – Two former employees of the Southwest Utah Public Health Department have been charged with second-degree felonies for Medicaid fraud.

Todd Alan Stirling, 51, and Russell Ammon Hinton, 38, both of Washington City, were each charged in 5th District Court Monday for filing more than 1,300 false Medicaid claims from October 2015 to February 2016.

The two were also charged with engaging in a pattern of unlawful activities related to the Medicaid claims. Both have been terminated from their positions at the Health Department.

(Stirling) received payments from SWUPHD for the over 1,300 false claims that were paid by Medicaid, as well as for over 3,000 additional claims that (he) submitted to SWUPHD, but which were not paid by Medicaid,” charging documents state.

The claims were submitted as part of the Targeted Case Management program, which is paid by Medicaid and offers support to new mothers, Washington County Commissioner Victor Iverson said. Iverson is a member of the Health Department’s governing board.

Two initial visits are paid for in full by Medicaid, with another series of about a dozen visits that Medicaid reimburses with a small amount.

The Health Department was doing the first initial visit, Iverson said, but did not have the staff nor the funding for the rest of the visits.

“What we have with the two individuals, especially with Todd (Stirling) … is they, on their own, without the knowledge of anybody in the leadership of Southwest Public Health, put themselves on the book as a subcontractor for Southwest Public Health,” Iverson said.

The two allegedly formed a company, started making calls and follow-up visits and billing the Health Department for the services.

They created this side company and employed their family members and then turned in invoices to Southwest Public Health, and they hadn’t followed any process, nobody knew about it. And since they were in a position to, they processed those claims which … benefited family members.”

According to charging documents, Stirling started a company, “Feel Good Management, LLC,” and used the company to hire employees, contact Medicaid recipients and submit improper invoices to the Health Department.

Hinton, who was the human resources manager at the time, was involved in Feel Good Management, court documents state:

“Defendant (Hinton) benefitted financially from his involvement with this enterprise as he made it possible for his wife, Megan Hinton, to be paid by Feel Good Management and/or as he received payment directly from the company.”

The allegedly fraudulent billing happened from October 2015 to February 2016, according to court documents.

When it came to the attention of Health Department officials, the operation was shut down and Stirling and Hinton’s employment was terminated, Iverson said. The Utah Attorney General’s Office began an investigation which culminated in the charges filed Monday.

Stirling, who was the Health Department’s director of nursing at the time, was giving Hinton the invoices for approval, Iverson said.

“They were making calls, they were doing it … I think the investigation showed that it didn’t meet the criteria of the program, and it wasn’t being done in the proper way,” Iverson said.

“The Health Department can contract things like this out, but you need to go through a bidding process. You need to have full disclosure,” Iverson said.

Stirling and Hinton were terminated for allowing a conflict of interest and not following the procurement code, Iverson said.

“We didn’t make an assessment at that time that it (the claims) were fraudulent,” Iverson said.

“The submission of those claims resulted in Medicaid funds being paid to SWUPHD (Southwest Utah Public Health Department) for services which were wholly or partially false given that they were not provided in compliance with Medicaid policy, were either never provided or were not provided as billed, and/or were not medically necessary,” court documents state.

Southwest Utah Public Health Department provides a multitude of services for the five-county area, which comprises Washington, Kane, Iron, Beaver and Garfield counties.

The department was required to repay Medicaid $72,760.10, Deputy Washington County Attorney Eric Clarke said, money which Stirling and Hinton may ultimately be responsible for.

“Because the Utah Attorney General’s Office is prosecuting the case, I can’t speak to how the case will be handled,” Clarke said.

“Generally, when a victim suffers a financial loss, the judge will order that the defendant repay the lost funds as restitution for the crime. I assume the health department will ask for restitution for the full amount … if there is a conviction.”

The Southwest Utah Public Health Department has since strengthened their policies and now have multiple checks on all grants that are received and administered through their divisions,” Health Department spokesman David Heaton said.

The health department has taken “pretty aggresive” action to prevent similar problems from occurring in the future, Iverson said.

The human resource director’s duties were redefined to prevent any conflict of interest, and a deputy director was hired to help the director with administrative duties, Iverson said.

An initial court appearance for both Stirling and Hinton is set for July 11 in 5th District Court. Both were ordered to appear at the Washington County Sheriff’s Office for processing and were to be released on their own recognizance, court documents state.

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Twitter: @STGnews

Copyright St. George News, LLC, 2017, all rights reserved.


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1 Comment

  • Utahguns June 7, 2017 at 7:07 pm

    This makes me think about the existence of Medicaid abuse that potentially exists on a national level.
    1,300 false Medicaid claims from October 2015 to February 2016 from a small geographical area like Southwest Utah?
    This is just the tip of a monsterous iceberg.
    Making this country great again includes the fumigation of corruption within the Medical industry.

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