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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