MISSOULA - Former Seeley Lake chiropractor Dr. Andrew Lance Bohlman, 48, entered a guilty plea Oct. 15 before Missoula County District Court Judge Jason Marks after being charged Sept. 25 with one count of Medicaid Fraud by common scheme, a felony. After a pre-sentence investigation was conducted, the defendant was sentenced Dec. 2 to six years at the Montana State Prison, deferred, and placed on supervised probation. Bohlman was also ordered to pay $100,000 in restitution to the Montana Medicaid Program in addition to other court ordered fees.
“We all have an interest in making sure taxpayer dollars are spent as they should be,“ said Attorney General Tim Fox in a press release. “I commend our Medicaid Fraud Control Unit, our Division of Criminal Investigation and Assistant Attorney General Mike Gee for protecting Montana’s public resources and securing a sentence tailored to both punish and rehabilitate this health care provider.”
Bohlman became a chiropractor in Montana in November 2011 and a Medicaid provider in January 2012. His chiropractic office was in Seeley Lake where he was a Medicaid provider and participant in the Montana Medicaid Program.
Medicaid coverage and reimbursements are available only for services or items that are provided in accordance with all applicable Medicaid requirements. A Medicaid provider (or any provider) can only submit claims for services that were provided (Mont. Admin. R. 37.85.406 (16)). Additionally, a Medicaid provider and licensed chiropractor must maintain patient records to support the provider’s claim for services rendered and to demonstrate the extent, nature and medical necessity of the services or items provided (Mont. Admin. R. 37.85.414(1)).
According to court documents, the investigation by the Montana Department of Justice’s Medicaid Fraud Control Unit (MFCU) began after Blue Cross Blue Shield made a referral in September 2016 to MFCU as well as the Surveillance and Utilization Review Section at the Montana Department of Public Health and Human Services. Both state agencies began simultaneous investigations.
Data review and interviews with patients and their parents revealed that from at least January 2012 to January 2016, Bohlman billed Medicaid almost exclusively for two types of chiropractic treatments, chiropractic manipulation of five regions of the back and chiropractic spinal adjustment. These two treatments were billed on almost every single patient on every single visit. Both of the services have high-paying reimbursement rates.
Court documents stated that not only were some patients seeing Bohlman for ailments other than those related to their backs but he was also billing for treatments that occurred when the patients weren’t there, were no longer patients or prior to ever meeting them. Additionally, when asked by MFCU investigators to provide treatment documentation, Bohlman was only able to submit 51 valid and accurate medical records for over 1,700 dates of service.
On Dec. 8, 2016, Medicaid payments to Bohlman were suspended as a result of DPHHS’s confidence that his billings were fraudulent. By that point, Bohlman had received at least $100,000 worth of public assistance monies based on the Medicaid claims he submitted.
Fox added in the press release, “The Montana Department of Justice will continue to seek out abuse of our public programs, and vigorously prosecute those who defraud the system. I encourage anyone who suspects Medicaid provider fraud to call our hotline at 1-800-376-1115.”
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