A licensed professional counselor and former operator of an Oklahoma City mental health facility pleaded guilty to multiple charges related to Medicaid fraud.
Charges of Defrauding Oklahoma Health Care Authority
John Michael Doneti, 51, operated Central Oklahoma Behavioral Health Services, LLC. He was accused of conspiring with a co-worker, counselor Angelique Williamson, to defraud the Oklahoma Health Care Authority.
Doneti was criminally charged after an investigation by the Oklahoma Attorney General's Office determined that Doneti and his alleged co-conspirator submitted $289,000 in fraudulent bills to the OHCA, the agency that oversees the state's Medicaid program. Doneti was accused of acts including submitting claims that indicated he worked more than 24 hours in a single day and submitting false invoices using another employee's personal information.
Initially, the defendant was charged with 9 felony counts:
- 5 counts of Medicaid Fraud
- 1 count of Conspiracy to Commit Medicaid Fraud
- 1 count of Identity Theft
- 1 count of Engaging in Transactions Involving Unlawful Proceeds
- 1 count of Conspiracy to Engage in Transactions Involving Unlawful Proceeds
Doneti pleaded guilty to 7 of the 9 charges, and 2 counts were dismissed at the request of the state: one count of Medicaid fraud and conspiracy to engage in transactions involving unlawful proceeds.
Sentencing for Conviction
Earlier this week, Attorney General E. Scott Pruitt announced Doneti's sentence. The former mental health facility operator is sentenced to 5 years in prison followed by 5 years of probation, during which time he is prohibited from billing Medicaid. Furthermore, he is ordered to pay $194,000 in restitution to the Oklahoma Health Care Authority.
The case against Williamson, his alleged co-conspirator, is pending.
Oklahoma's Fraud Laws
Most state crimes are codified in Title 21 of the Oklahoma Statutes. Medicaid fraud, however, is defined, in 56 O.S. § 1005. Under the Oklahoma Medicaid Program Integrity Act, it is illegal to "willfully and knowingly" commit any of the following acts:
- Make or cause to be made a claim, knowing the claim to be false, in whole or in part, by commission or omission;
- Make or cause to be made a statement or representation for use in obtaining or seeking to obtain authorization to provide a good or a service knowing the statement or representation to be false, in whole or in part, by commission or omission;
- Make or cause to be made a statement or representation for use by another in obtaining a good or a service under the Oklahoma Medicaid Program, knowing the statement or representation to be false, in whole or in part, by commission or omission;
- Make or cause to be made a statement or representation for use in qualifying as a provider of a good or a service under the Oklahoma Medicaid Program, knowing the statement or representation to be false, in whole or in part, by commission or omission;
- Charge any recipient or person acting on behalf of a recipient, money or other consideration in addition to or in excess of rates of remuneration established under the Oklahoma Medicaid Program;
- Solicit or accept a benefit, pecuniary benefit, or kickback in connection with goods or services paid or claimed by a provider to be payable by the Oklahoma Medicaid Program; or
- Having submitted a claim for or received payment for a good or a service under the Oklahoma Medicaid Program, fail to maintain or destroy such records as required by law or the rules of the Oklahoma Health Care Authority for a period of at least six (6) years following the date on which payment was received.
Medicaid fraud in which the value of benefits or payments wrongfully received is less than $5,000 is a misdemeanor, but if the aggregate amount is $5,000 or greater, Medicaid fraud is a felony punishable by a maximum of 5 years in prison for each count.