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The Case of Dentist Roy S. Shelburne

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Dr. Roy S Shelburne and dental student (VCU) son Ross

Ok, what the FRAK is going on with this case?

The press release of the dentist’s indictment is here.

United States Attorney John L. Brownlee and Virginia Attorney General Bob McDonnell announced today that Roy Silas Shelburne, age 51, of Pennington Gap, Virginia, was indicted by a federal Grand Jury sitting in Abingdon, Virginia.

Shelburne was charged in an eight count indictment with racketeering, healthcare fraud, mail fraud, wire fraud, money laundering, and interstate transportation of monies taken by fraud after a joint investigation by the Virginia Attorney General’s Medicaid Fraud Control Unit, the Internal Revenue Service, and the United States Attorney’s Office.

“The Grand Jury has charged that Roy Shelburne was lining his own pockets by over billing Medicaid. Time after time, Medicaid was billed for services not performed, or services that were not needed,” said United States Attorney John Brownlee. “Shelburne gave no thought to the needs or the quality of care provided to his patients. In some cases, the work that was done was performed in such a manner that it was the equivalent of having no dental services performed at all.”

A press account of Dr. Shelburne’s conviction is here.

United States Attorney John L. Brownlee and Virginia Attorney General Bob McDonnell announced today that Roy Silas Shelburne, age 51, of Pennington Gap, Virginia, was found guilty today by a federal jury in Abington, Virginia, on all ten felony charges.

“Roy Shelburne acted in a cruel and inhumane manner by performing unnecessary and extremely painful dental procedures on children. Shelburne’s criminal conduct towards 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,” U.S. Attorney John L. Brownlee said today. “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.”

Key Graphs:

  • 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 over billing 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 which 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. 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 contemporaneously 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.

But, now various “CLOSED – MEMBERSHIP ONLY” Dentist forums are ablaze with righteous indignation over Dr. Shelburne’s conviction. He is currently on bail awaiting sentencing on June 16th.

A Florida dentist, Dr. Mike Barr has created a website to plead Dr.Shelburne’s case: Errant Medicaid Investigation Ruins Good Dentist.

So, what is the story?

Has there been a breakdown in the criminal justice system? Or is this merely a plea by a convicted felon that he did not commit the crimes? Or a convicted criminal attempting to drum up sympathy for a lighter sentence, new trial or a verdict set aside?

Dr. Shelburne WAS indicted by a Federal Grand Jury and convicted by a jury. Yet, he and other dentists claim in numerous posts on the “closed sites” that he was treated unfairly?

Stay tuned…….


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9 thoughts on “The Case of Dentist Roy S. Shelburne

  1. What is upsetting is that RICO stautes were used. These were meant for Mafia and terrorists. All they could find was $8000 in billing errors over 5 years. That’s $133 a month, or if he worked 20 days a month … less than $7.00 a day. Does facing 120 years in jail, losing your license so now you can’t work, face a fine of over a million bucks, having everything you’ve earned cofiscated seem fair for $7 a day billing errors?

  2. This is what is alleged by Dr. Shelburne. Since I did not sit on the jury in the trial and listen to all of the evidence I cannot accept your premise.

    RICO statutes have a role to play in combating crime and I do not think you can oversimplify by restricting its use to Mafia or terrorists. There are other organized criminal enterprises.

    If this was a case of simple billing errors, I doubt a federal grand jury would have indicted Dr. Shelburne.

    There has to be more to this story and I am waiting to hear it.

    Maybe we will have to wait for sentencing.

  3. 1. this investigation begin over 3 yrs ago. Using the RICO act his possesions and accounts were frozen “BEFORE” ever going to trial (hard to mount a defense without money).
    2. Medicaid, VA dept.of health and private ins. investigators found billing errors but no indication of intentional fraud.
    3. I recall another public official In a Duke case abusing his power for self promotion.

  4. RE:

    #! Standard in RICO cases to freeze assets

    #2 I believe one of the elements of the crime to convict Dr. Shelburne is intent. So, the jury must have found this proven.

    #3 Irrelevant

    Got anymore?

  5. This is a worrying trend over here too. Laws that were intended to fight the war on terror have been used by local councils to snoop on individuals accused of living outside the catchment areas of good schools, people putting their trash cans out the wrong day and those who use exeptionally long sentence.

    Portishead Dentist

  6. Mr. Roy Shelburne was convicted rightly and justly. I was once a patient in his chair and I can say he charged prices beyond anyone’s means in our area. I had over two hundred dollars in my pocket to pay for one (count them…one!) tooth to be filled. NOT capped, not root canal…not even pulled…but filled. He put me in the chair, I had an x-ray done and then he calmly (with a large smile) said I needed around two hundred more for the tooth to be fixed with novicaine and a filling. He said he could not do any more work (after popping out my original filling) until I brought him this money. I was told to have my mother go get it from her bank and loan it to me, since I could not seem to get credit with the financial papers he offered in his office. This man then filled my tooth with a TEMP filling. I paid around $400 for a temp filling in a tooth. It wasn’t even a root canal!

    I smiled when he got sentenced, so did many others in our small town!

  7. And there is more to the case than those websites are stating. You would have to read the trial transcripts to know things that were not even mentioned by his online supporters. They had a website up that insulted the people of Lee County and then asked for donations to help him. It was on that Medicaid Ruins Good Dentist site but someone rewrote it after the people of Lee wrote about it on the Topix forum. Now the Good Dentist site is gone, I wonder why?

    http://www.topix.com/forum/city/dryden-va/T1K200AR7IN5AUJ4Q/p2

    From his own words: http://limoli.com/Announcment_to_the_Dental_Community%5B1%5D.pdf Where he states he is unable to provide for his family and they will be left to fend for themselves. His son has taken over the practice, his wife used to work in real estate I believe, why not again.

    From the newspapers:

    [quote]
    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.

    [/quote]

    [quote]

    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.

    [/quote]

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