Decatur Pediatrician Charged with Health Care Fraud

SPRINGFIELD, IL—A pediatrician who has practiced in Decatur, Illinois, Jamie S. Warnick, is scheduled to appear in federal court in Springfield on Dec. 17, after being charged in a criminal complaint with health care fraud. According to the affidavit filed in support of the complaint on Nov 13, Warnick was the sole physician practicing as Decatur Pediatric Clinic, at 1770 E. Lake Shore Drive, Suite 300, Decatur, Illinois.

The affidavit alleges that Warnick, 53, defrauded a federally funded health care benefit program as well as private insurance companies. Warnick allegedly engaged in a pattern of making false statements and submitting fraudulent information and documents to obtain free vaccines under false pretenses from the U.S. Centers for Disease Control through the Illinois Department of Public Health. The affidavit alleges Warnick obtained vaccines, at no cost to her, meant primarily for children without health insurance and for under-insured children, whose insurance did not pay for vaccines. On multiple occasions, from 2005 until October 2008, Warnick allegedly administered the vaccines to patients who did not qualify and often billed insurance companies for it.

The federally-funded Vaccines for Children (VFC) program provides vaccines at no cost to children who might not otherwise be vaccinated because of an inability to pay. Created in 1993, the VFC became a required part of each state’s Medicaid plan and was officially implemented in October 1994. Federal funding is ultimately allocated to the Centers for Disease Control and Prevention (CDC). CDC buys vaccines and distributes them to grantees, such as state health departments and public health agencies, which distribute them at no charge to private physicians’ offices and public health clinics registered as VFC providers.

The affidavit alleges that Warnick submitted an application in 2005 to the Illinois Department of Public Health to become a provider for the VFC program. Before vaccines are administered, the child’s parent or guardian must complete a form to certify the child’s eligibility. The affidavit alleges that parents of numerous patients were asked to sign the form on Warnick’s recommendation even though they had health insurance to cover the vaccines. Further, a number of vaccines were allegedly billed to the insurance companies by Warnick as if the vaccine had been purchased by Warnick. The affidavit does not allege a specific amount of loss to Medicaid or private insurers.

Warnick’s court appearance is scheduled at 11:30 a.m. on Dec. 17, 2009, before U.S. Magistrate Judge Byron G. Cudmore in Springfield.

If convicted, each count of health care fraud carries a statutory penalty of up to 10 years in prison and a fine of $250,000 or twice the defendant’s gain or loss to the victim.

The investigation is being conducted by the Central Illinois Health Care Fraud Task Force which includes agents of the U.S. Health and Human Services Office of Inspector General, Federal Bureau of Investigation, the Illinois State Police’s Medicaid Fraud Control Bureau, U.S. Postal Inspection Service, Illinois Attorney General’s Office and the Illinois Department of Public Health. Assistant U.S. Attorney Patrick D. Hansen is prosecuting the case.