Medical Biller Charged with Diverting Opioids and Federal Health Care Fraud

WILMINGTON, Del. – Benjamin L. Wallace, U.S. Attorney for the District of Delaware, announced today that a federal grand jury in Wilmington, Delaware, returned an indictment charging Ty Mauldin, 34, of South Dakota, with ordering thousands of opioid pills by stealing the identity of medical professionals with whom he worked.  The grand jury also charged Mauldin with health care fraud for causing fraudulent submissions to Medicaid and a private health insurer.

According to court documents, Mauldin worked as a medical biller and credentialer, that is, he helped medical professionals and organizations contract with health insurers, including Medicaid, and helped medical providers bill those insurers for services.  Through that business, Mauldin gained access to the professional licensure information for medical professionals.  He used that access—and the name and licensure information of medical professionals—to order himself thousands of opioid pills through wholesale pharmaceutical suppliers and prescribe himself opioids.  He did that without the approval—or the knowledge—of the medical professionals whose name and licensure information he used.

Mauldin also used his access to his own electronic medical records to falsify his own personal health records.  He used those falsified health records, and additional forged medical documents, to present as a cancer patient requiring pain management services. Based on those false representations, he was treated by a pain management doctor and caused his private health insurer to pay for those services.  Those services included the installation of an intrathecal pain pump and the prescription of opioids, all done based on Mauldin’s forged medical records.

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