Thomaston Pediatrician Pleads Guilty to Medicaid Fraud

Kathy Mansfield, a Thomaston pediatrician and owner of Pediatric Associates of Thomaston, Inc., pled guilty yesterday to one count of Medicaid Fraud for intentionally overbilling the Medicaid Program in the amount of approximately $537,428.

From 2003 to 2007, Mansfield billed Medicaid for the Synagis, a drug used to prevent severe lower respiratory infections in infants and young children, for substantially greater amounts of the drug than she actually purchased and used on patients at her clinic. The fraudulent billing scheme had two parts.  Synagis vials are labeled as “single-dose” or “single-use” only, and the Food and Drug Administration’s approved instructions state that any remaining amount of the drug in a vial should be discarded after removing a patient’s dose. Mansfield instructed her staff to use any remaining amount of the drug in vials after a dose was drawn on subsequent patients, but bill Medicaid as if a new vial was used for each patient. Mansfield’s practice also always billed for the larger and more expensive 100 mg size vial of Synagis, rather than the less expensive and smaller 50 mg size vial. The 100 mg size vial cost between $1,100 and $1,300 per vial.

The State recommended a sentence of 10 years with 4 years of incarceration, restitution, investigative costs and fines. Despite the State’s recommendation for incarceration, the judge imposed a sentence of ten years on probation, restitution in the amount of $537,428, a $10,000 fine and investigative costs to be repaid to the state in the amount of $5,000.”

Assistant Attorney General Victoria L. Kizito, who is assigned to the Georgia Medicaid Fraud Control Unit, prosecuted Mansfield on behalf of the State of Georgia.