Vcu 81 dental grad convicted of fraud

Trial begins for dentist accused of racketeering
Wednesday, Feb 20, 2008 - 02:00 AM
BY Daniel Gilbert
Reporter
ABINGDON, Va.– To begin each day at his Pennington Gap, Va., dental practice, Roy Silas Shelburne called a staff "huddle."
The purpose, as a witness described Tuesday in Shelburne’s fraud trial in federal court, was to go over "production goals" – dollar totals each department was supposed to meet.
The daily huddle is key circumstantial evidence in the prosecutors’ portrait of Shelburne – a dentist they claim was motivated by profit margins, who performed shoddy and unnecessary procedures on young, low-income patients, while bilking insurance companies and Medicaid to finance a lavish lifestyle.
Shelburne’s defense attorney told a different story to jurors, describing the defendant as a Lee County, Va., native devoted to serving his low-income clientele even though Medicaid reimbursed him much less than private insurance companies.
Shelburne, 52, was indicted in 2006 on charges of racketeering and numerous counts of fraud. Prosecutors allege that between 1998 and 2004, the defendant collected from Medicaid – administered through the Virginia Department of Medical Assistance Services (DMAS)– for "medically unnecessary" procedures and services he did not provide, often maximizing profit by billing DMAS and private insurance companies for the same procedure.
If convicted on all counts, Shelburne could face up to 120 years in prison.
Much of the trial is expected to focus on the intricacies of billing protocols and dental procedures like "pulpotomies" – when the pulp chamber of a badly decayed tooth is scooped out and the tooth is crowned.
Assistant U.S. Attorney Anthony P. Giorno referenced the case of one 6-year-old patient on whom Shelburne performed four pulpotomies; allotting approximately the same time for that operation as for a routine teeth cleaning for his wife, who happened to have an appointment the same day.
In anticipation of the prosecution’s evidence, defense attorney Dennis E. Jones warned jurors that the physical evidence – such as X-rays – is missing a dimension from a dentist’s 3-D perspective while performing a procedure. Witnesses who question the need for a given procedure after the fact, Jones said, are engaging in "Monday morning quarterbacking."
Prosecutors Tuesday also entered as evidence a photo of Shelburne’s house – an 8,000-square-foot structure with a home theater – and described a day in 2006 when he purchased two luxury automobiles for his daughters.
"He made money he was not entitled to make off the backs of children," Giorno told jurors.
Jones did not dispute his client’s affluence – "It is true that he has a nice house" – and acknowledged that his office had made some "clerical errors" in billing the state and insurance companies.
But he rejected the allegations that Shelburne knowingly submitted fraudulent statements, and argued such financial micro-management alleged by the prosecution would have been "an impossible task" for his client, the only full-fledged dentist in the practice.
The first day of trial finished with testimony from the prosecution’s first witness, Phyllis Shackelford, a dental assistant to Shelburne, who described her ex-boss as "knowledgeable" about the office’s finances.
In daily "huddles" of 15 or 20 minutes, Shackelford testified, Shelburne would go over "how much money each member was supposed to meet."

dgilbert@bristolnews.com |

cont.from bristol herald courier

If staff did not meet the financial targets, Shelburne warned of cutting back on his employees’ hours and benefits, and possible layoffs, Shackelford testified.
Shackelford also told jurors she frequently had doubts about whether some of the procedures Shelburne performed were necessary.
"Sometimes I just didn’t see some of the things he seen," she testified.
Questioned by assistant prosecutor Michelle Brooks if she ever questioned Shelburne, Shackelford said she had not.
"I’m not a doctor," she responded.
Western District of Virginia Chief Judge James P. Jones said he expected the trial to last well into next week.
dgilbert@bristolnews.com |

Vanishing credit balances and procedures not performed that ended up on insurance claims.

Roy Silas Shelburne is accused of a defrauding the state and private insurance companies by overcharging them for dental work, billing for unnecessary or unperformed procedures, and collecting multiple times on the same bill.

Witnesses Wednesday testified that on numerous occasions credit remaining in the accounts of some patients who lost Medicaid benefits had been "zeroed out," obliging them to pay out of pocket.

Cindy Wade, Shelburne’s former financial coordinator, testified that such credit balances vanished overnight, while unperformed procedures she deleted nevertheless found their way into insurance claims.

As financial coordinator, it was Wade’s responsibility to square treatment plans with dental work that was performed, as recorded in patient charts, and input the billing information into the office’s computer system.

Wade testified Wednesday that she found discrepancies between what a patient was scheduled for and what work was actually performed often "a couple of times a day." She recalled deleting procedures that were not performed only to see them reappear on insurance claim forms.

Under questioning from assistant prosecutor Michelle Brooks, Wade said she submitted medical claims she knew to be false after trying to correct them in vain.

"Finally I just thought,‘You know what? Whatever,’ " she testified, saying she was "intimidated" by Shelburne, who would become "irate and upset" on the occasions when she questioned him about billing discrepancies.

While several former employees testified that Shelburne often submitted bills himself, none of them said they saw him falsify information.

Defense attorney Dennis E. Jones questioned whether his client’s former employees had an incentive to overcharge the state and insurance companies, noting that Shelburne gave financial bonuses to departments for meeting monthly "production goals."

Rather than overcharging for insurance, Jones submitted that Shelburne did not bill Medicaid for nitrous oxide – commonly known as laughing gas – which is covered.

Witnesses, however, described a double standard for Medicaid patients imposed by Shelburne.

Jammie Koomer, Shelburne’s appointment coordinator, testified that her boss instructed her not to include a form called a "Guarantee of Services" – informing patients of a right to have corrective work done free of charge – to Medicaid patients.

She also testified Shelburne said he was "working too hard" for his Medicaid patients, and the reimbursements were too small.

dgilbert@bristolnews.com |

Jury Grows Weary In Federal Trial of Scott County, Va., Dentist
Friday, Feb 29, 2008 - 01:15 AM
BY Debra McCown
Send e-mail
Bristol Herald Courier
ABINGDON, Va.– Slouching in their seats after nearly two weeks in federal court, jurors continued to hear testimony on Thursday in the federal fraud trial of Lee County dentist Roy Silas Shelburne.
Shelburne is accused of performing unnecessary dental procedures on low-income patients, including children, and collecting payment multiple times for the same treatment.
Thursday afternoon the jury heard from Tom Limoli, president of Atlanta Dental Consultants, who gave expert testimony for the defense about the clinical and billing records at Shelburne’s practice.
Defense attorney Dennis Jones took Limoli line-by-line through a long list of alleged acts of wrongdoing at the dental practice; by mid-afternoon, Judge James P. Jones interrupted the testimony and sent the jury out of the room.
"The jury’s been here two weeks, and they’re really groggy. I’m not sure how much of this they’re taking in" Jones told the lawyers. "I’ve been observing the jury this afternoon, and they’re beat."
Jones suggested the defense attorney have his witness summarize the information, and once the jury came back in, he did so.
"Those services that appear on the billing statements and run sheets were very consistent with the doctor’s clinical notations," Limoli said.
On the issue of alleged double-billing, Limoli said dealing with multiple insurance providers is a complicated proposition.
"Coordination of benefits is a nightmare in the dental field," he said. "Fewer and fewer plans are working together."
He said that in general, the information he was provided showed that in the cases in question, the first insurance plan was billed and then the second plan was billed later.
In cross-examination, special Assistant U.S. Attorney Michele Brooks asked Limoli specific questions about his testimony, and he acknowledged that he lacked certain pieces of information about the billing.
Further questioning him about his analysis of Shelburne’s billing practices, Brooks said consistency between clinical notation and billing was not evidence that "upcoding" – or billing for more than procedures that were actually performed – did not occur.
dmccown@bristolnews.com

3:45 p.m. UPDATE: Federal Fraud Trial of Lee County Dentist Recesses
Closing Arguments to Begin Wednesday

Tuesday, Mar 04, 2008 - 12:03 PM

BY Debra McCown
Send e-mail

Bristol Herald Courier

The federal fraud trial of a Lee County dentist was recessed at about 2:30 p.m. today until Wednesday morning, when the jury will hear closing arguments.

Court resumes at 9 a.m. Wednesday. The jury is expected to get the case by noon.

----------

ABINGDON, Va.- Roy Shelburne was calm on the witness stand this morning during hours of cross-examination in his federal fraud trial.

The Lee County dentist is accused of performing unnecessary dental procedures on low-income patients, including children, and collecting payment multiple times for the same treatment.

Shelburne was questioned today about billing at his practice, the quality and necessity of services provided and the purchase of cars for his daughters. The prosecutor was asking Shelburne about dental work done to some of his patients' baby teeth when the court broke for lunch.

The case is expected to be in the hands of the jury by day’s end.

Check back on TriCities.com for updates and read Wednesday's Bristol Herald Courier for a wrap-up of today's day in court.

.

Daily News, Weather and more from the Bristol Herald Courier, News Channel 11, & TriCities.com
Terms & Conditions |© 2008 Media General, Inc.| FCC EEO Info

3:45 p.m. UPDATE: Federal Fraud Trial of Lee County Dentist Recesses
Closing Arguments to Begin Wednesday
Tuesday, Mar 04, 2008 - 12:03 PM
BY Debra McCown
Send e-mail
Bristol Herald Courier
The federal fraud trial of a Lee County dentist was recessed at about 2:30 p.m. today until Wednesday morning, when the jury will hear closing arguments.
Court resumes at 9 a.m. Wednesday. The jury is expected to get the case by noon.
----------
ABINGDON, Va.- Roy Shelburne was calm on the witness stand this morning during hours of cross-examination in his federal fraud trial.
The Lee County dentist is accused of performing unnecessary dental procedures on low-income patients, including children, and collecting payment multiple times for the same treatment.
Shelburne was questioned today about billing at his practice, the quality and necessity of services provided and the purchase of cars for his daughters. The prosecutor was asking Shelburne about dental work done to some of his patients' baby teeth when the court broke for lunch.
The case is expected to be in the hands of the jury by day’s end.
Check back on TriCities.com for updates and read Wednesday's Bristol Herald Courier for a wrap-up of today's day in court.
.
Trial of Lee County Dentist to Continue for Another Day Judge Rules
Wednesday, Mar 05, 2008 - 01:45 AM
BY Debra McCown
ABINGDON, Va.– The fraud trial of Lee County dentist Roy Silas Shelburne will continue for another day, a federal judge decided Tuesday.
Closing arguments are to be held today, and the case is expected to be in the jury’s hands by lunchtime.
Shelburne is accused of doing unnecessary dental work on children and double-billing for dental services.
He was calm through hours of cross-examination on Tuesday, when he testified that while his staff may have made billing and record-keeping errors, there has been no wrongdoing.
"Sir, I’ve never billed for anything that I did not believe was necessary," Shelburne said. "If we ever received any payment that we were not entitled to ... then we returned that money."
Prosecutors also asked about his personal assets, including cars purchased for his daughters, and his house, which has a mortgage of more than $500,000.
He testified he did not try to shield his assets from seizure during a lengthy investigation of his dental practice, and that he was not under stress to meet more than $17,000 in monthly expenses.
He said the dental care he provided was necessary in his professional judgment.
"I’ve never said that what I’ve done has been perfect. I am human. I do make mistakes, sir," Shelburne said. "In every instance, in every service I have provided to my patients, I have tried my very best.

Federal Jury to Continue Deliberation Today in Dentist Case

Thursday, Mar 06, 2008 - 01:30 AM
BY Debra McCown
Bristol Herald Courier

ABINGDON, Va.– Jury deliberation continues today in the federal fraud case of Roy Silas Shelburne, a Lee County dentist accused of doing unnecessary dental work and double-billing for dental services.

After four hours of considering the case Wednesday afternoon, the jurors decided to break for the night and return at 9 a.m. today.

When the case was placed in the jury’s hands, Shelburne and about two dozen supporters – family members and members of his church family – huddled in a hallway outside the courtroom, where they prayed for "truth and justice."

The preacher, who would not give his name, asked them to remember the Biblical story of Joseph, who repeatedly suffered hardships through no fault of his own.

"In every bad situation in this book, the worse it gets, the better God is," he said. "As bad as this situation is, we ought to be expecting something great from God."

The jury heard closing arguments in the case Wednesday morning.

Special Assistant U.S. Attorney Michele Brooks reviewed more than two weeks of testimony in the case, including that of several of Shelburne’s patients.

"The health-care fraud is really what this case is all about," Brooks said. "A parent should be able to trust the word of the health-care provider to tell them the truth ... especially for a small child."

She recalled the cases of a 6-year-old boy whose mother testified about four of his teeth Shelburne intended to drill but have never needed repair, a teenager who has false teeth after failed root canals and a woman who said she received three fillings, not the 15 claimed.

Brooks recalled Shelburne’s employees, who testified that they would delete procedures not performed from the office computer, only to see them magically reappear – and credit balances on patients’ accounts would also disappear.

She recalled the testimony of local dentists who questioned Shelburne’s work.

She said Shelburne – not Medicaid or his employees – is to blame for fraud she claimed he committed against the most vulnerable of his patients.

Defense Attorney Dennis E. Jones reminded the jury of the presumption of innocence under U.S. law. He focused on the variation of different dentists’ professional judgment and the involvement of Medicaid authorities in the health-care process.

"In every case wherein Dr. Shelburne did a root canal, there’s somebody in Richmond authorizing and approving it," Jones said.

He also blamed the failures of a large, bureaucratic agency for billing errors, saying overpayments were made by Medicaid despite proper submission of billing forms.

He recalled the testimony of a dentist who challenged claims that particular dental work of Shelburne’s was unnecessary.

"Success is not built on a bad-work product," Jones said, discussing the 25-year success of Shelburne’s dental practice. "Y’all know that.... It’s built on a good-work product, it’s built on the service that you provide and, to a certain point, it’s built on the way you treat people."

He referred to Shelburne as a humanitarian and said the amount of money allegedly stolen in specific acts was small compared to overall business revenue.

While Jones referred to second-guessing of Shelburne’s judgment as "Monday morning quarterbacking," assistant U.S. Attorney Anthony Giorno said the dentist’s decisions were "so far outside the goalpost as to not even be arguably within judgment."

Questioning Shelburne’s integrity, Giorno made light of family cruises he said Shelburne wrote off and pricey accommodations enjoyed en route to charity work in Honduras.

"Ask yourselves when you get back in the jury room," Giorno said, "Would I trust Dr. Shelburne enough to bring my child there?"

Supporters Of Lee County, Va., Dentists Can't Believe Guilty Verdict

Friday, Mar 07, 2008 - 01:30 AM

BY Debra McCown
Send e-mail

Bristol Herald Courier

Email to a Friend Printer Friendly

ABINGDON, Va.– Roy Silas Shelburne will face up to 120 years in prison and a fine of up to $1.25 million after his conviction Thursday on 10 felony charges involving his dental practice in Pennington Gap, Va.

After more than seven hours of deliberations over two days, a federal jury found Shelburne guilty of health-care fraud, racketeering, structuring a transaction to avoid reporting requirements and seven counts of money laundering.

His wife and three grown children, who have supported him throughout the lengthy ordeal, burst into sobs, surrounded by tearful supporters as the jury read its verdict.

"All things work for the good of those who love the Lord and according to his purpose, even this," Shelburne said as he left the courtroom Thursday afternoon. "May he be glorified."

Shelburne remains free on bond pending sentencing June 9.

"We’re just flabbergasted," said his mother, A. Drucelle Shelburne, after the verdict was read. "It’s just absolutely unbelievable – inconceivable."

The trial was attended by about two dozen supporters – family members and friends who maintained their belief in his innocence.

"All things work together for those who love the Lord," said daughter, Erika, echoing the statements her father has made since his 2006 indictment.

With a successful dental practice that allowed him to pay for a large home, expensive cars and extravagant trips to do charity work abroad, Shelburne had been considered a pillar of his Lee County community.

Based on state code, his conviction means the immediate suspension of his license to practice dentistry, effectively shutting down his practice.

At least two of his employees were present when the verdict was read Thursday.

"It was a wonderful place to work, and things was said untrue from people who testified against him," said one staff member, speaking for herself and a colleague. "He’s kind and considerate, and he’s the best dentist I’ve ever worked for."

The women did not give their names, citing concerns that their comments might make it difficult for them to find new jobs.

U.S. Attorney John Brownlee said Shelburne abused a position of trust as a dentist to whom families came for help when they needed dental treatment, and he performed painful, unnecessary procedures on children to satisfy his greed.

"Shelburne’s criminal conduct toward these poor families and young foster children is one of the worst cases of abuse and fraud I have seen in my many years in law enforcement," Brownlee said.

"I’m just grateful to the jury for holding him accountable for his conduct."

Pennington Gap dentist found guilty of racketeering, fraud
ABINGDON — Pennington Gap dentist Roy Silas Shelburne was found guilty Thursday by a federal jury in Abingdon of 10 felony charges including racketeering, health care fraud, mail fraud, wire fraud and money laundering
According to a news release from U.S. Attorney John L. Brownlee and Virginia Attorney General Bob McDonnell, Shelburne, 51, now faces a maximum penalty of 120 years imprisonment and a fine of $1.25 million. As a result of the conviction, Shelburne has agreed to forfeit $200,000 to the federal government in addition to mandatory restitution in an amount to be determined by the court at sentencing. Shelburne remains free on bond pending his sentencing hearing June 9 in Abingdon.
“Roy Shelburne acted in a cruel and inhumane manner by performing unnecessary and extremely painful dental procedures on children. Shelburne’s criminal conduct toward these poor families and young foster children is one of the worst cases of abuse and fraud I have seen in my many years in law enforcement,” Brownlee said.“I am grateful that this jury held Mr. Shelburne responsible for his crimes. My thanks and gratitude go out to all the state and federal agents and prosecutors who worked tirelessly to bring the defendant to justice.”
Shelburne was found guilty of racketeering, health care fraud, structuring and money laundering. The charges arose from a joint investigation conducted by the Virginia Attorney General’s Medicaid Fraud Control Unit, the IRS and the U.S. Attorney’s Office.
According to the evidence presented at trial by Assistant U.S. Attorney Anthony P. Giorno and Assistant Attorney General Michelle Brooks, beginning in 1998 Shelburne, who was a licensed dentist with a practice in Pennington Gap, executed a scheme to maximize his practice’s income by overbilling insurance carriers and Medicaid for services that were never performed and for services that were performed but not medically necessary.
In addition, Shelburne directed his employees to bill patients for services that were never performed or that were unnecessary. All of the patients Shelburne falsely billed were low-income, underage patients who were recipients of Medicaid. A portion of the underage patients were residents of the Harvest Child Care Ministries group home.
According to the evidence presented at trial, Shelburne would “upcode” the bills for some of his patients.“Upcoding” is the process of performing one procedure but billing for a different procedure, one that requires a higher payment from Medicaid and private health insurance providers.
In some cases, Shelburne would submit bills for services that were incomplete or medically unnecessary. At times, he performed services that endangered the health of his patients.
On several occasions Shelburne billed both Medicaid and private health insurance companies for services he performed in connection with a single procedure, collected money from both agencies, and failed to reimburse either for the fraudulent fees he collected. Many times this created credit balances on the patients’ account that, according to his employees, Shelburne would simply “zero out” without reimbursing Medicaid.
According to the evidence presented at trial, Shelburne submitted at least 115 false billing statements by mail. The defendant took part of the fraudulently obtained funds and transferred them into a retirement account in Illinois. The evidence showed that Shelburne used some of the funds to build a new home known to his employees as the “Cavity Castle,” purchase luxury vehicles for himself and his family, and took his family on cruises that were deducted on his books as board expenses.

continued...

In addition, he put his three children on the company payroll when, according to his employees, they provided no services. The salaries paid to the children were deducted as business expenses. Shelburne used part of the fraudulently obtained funds to pay his salary, purchase dental supplies, and pay rent for his business and equipment.

In addition, Shelburne was convicted of structuring cash deposits at both BB&T Bank and Rick Hill Imports, a luxury car dealership, in an attempt to evade the currency transaction reporting requirements. With the structured funds, he purchased a used 2006 Mercedes SUV and a new 2006 Mercedes SLK coupe in the names of family members.

On cross-examination, Shelburne testified that the structured funds were part of a cash horde that he had accumulated to hide assets from investigators.
.

Mr she;lburn tells a different story at medicaidruinedagooddentist.com . Also, the county he lives in has 2 other medicaid providers. One is only 5 miles away from the xdentists office Also, the amount is was not $8thou, more like100's of thou as reported. His son is presently a student at vcu!!