Insurance Company Fraud, Bogus Claims Under Investigations

ST. ANTHONY — An employee of a durable medical equipment company has been sentenced for “provider fraud.” He was charged with 25 counts of fraud committed between May 1, 2013, and April 30, 2017, in Jefferson County.

On Thursday, Idaho State Attorney General Lawrence Wasden announced that Elwood Conica, 46, of St. Anthony, had pleaded guilty to the charges in January. Conica worked for the 4T Medical Supply Company and was arrested in Jefferson County.

Seventh District Court Judge Stevan Thompson sentenced Conica to five years in prison. The judge also ordered the defendant to pay $33,613 in restitution to the Idaho Department of Health and Welfare, a $500 fine, and $500 toward public defender costs. The court also ordered Conica to pay court costs, Wasden reported.

The investigation showed that Conica billed Medicaid and then misappropriated Medicaid funds that should have been used on the clients’ behalf.

“This resulted in clients not receiving all of the required healthcare products Medicaid funding should have provided them,” he said. “In some cases, patients were forced to use their own money to purchase products as a result of the gap created by Conica’s fraudulent behavior.”

Wasden reported that the investigation also showed that Conica billed Medicaid for more pricey items.

“The investigation also revealed Conica billed Medicaid for certain, more expensive products, then provided patients with an entirely different product that was not covered by Medicaid, while pocketing the difference for his own personal use,” Wasden said.

The products involved are what’s called “solid skin barriers.” According to the Wound Management and Prevention webpage, the barriers serve, as the name implies, as barriers between Ostomy bags and the skin.

The Idaho Department of Health and Welfare’s Medicaid Program, Integrity Unity, discovered Conica’s fraud in July 2016. The Attorney General’s Medicaid Fraud Control Unit investigated the case. Deputy Attorney General Rondee Blessing prosecuted the case.

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