CHARLESTON, WV (LOOTPRESS) – A Winfield nurse practitioner has pleaded guilty to health care fraud after admitting to filing false claims for medical services that were never provided.
Shawn R. Blankenship, 54, the owner of Holistic Inc., a medical clinic in St. Albans, pleaded guilty to four counts of health care fraud in federal court on Monday.
According to court documents, Blankenship knowingly submitted fraudulent claims to Medicaid and its Managed Care Organizations for services that were not medically necessary or never performed.
Prosecutors said Holistic primarily offered opioid treatment, weight loss counseling, and smoking cessation services.
However, an investigation revealed that certain claims submitted to Medicaid required a licensed provider to be present, which was not the case.
Blankenship admitted to filing four false claims, including three for smoking cessation services and one for a 15-minute outpatient visit, allegedly conducted on October 29, 2020.
Investigators determined that neither Blankenship nor any other licensed providers from his clinic were in the state on that date, as they were in Hilton Head, South Carolina.
Authorities estimate the total losses from Blankenship’s fraudulent billing practices at approximately $600,000.
Blankenship is set to be sentenced on July 21, 2025, and faces up to 40 years in prison, at least three years of supervised release, and a $1 million fine.
He also owes restitution, with the exact amount to be determined by the court.
The guilty plea follows a multi-year investigation into fraudulent medical billing practices in southern West Virginia.
The case was investigated by the U.S. Department of Health and Human Services-Office of Inspector General, the FBI, the West Virginia Medicaid Fraud Control Unit, the DEA, and Homeland Security Investigations.
United States Magistrate Judge Omar J. Aboulhosn presided over the hearing. The case is being prosecuted by Trial Attorney Jody King of the U.S. Department of Justice Criminal Division-Fraud Section and Assistant United States Attorney Owen Reynolds.
