MEDICAID FRAUD REPORT

Transcription

1 MEDICAID FRAUD REPORT National Association of Medicaid Fraud Control Units May/June 2012 INSIDE Virginia MFCU Announces Guilty Verdict Of Group Home Owner... 1 Cases... 2 Case Updates Virginia MFCU Announces Guilty Verdict Of Group Home Owner Attorney General Ken Cuccinelli announced on May 7 that Richard C. Wagoner, Jr., was found guilty of abuse and neglect of an incapacitated adult that resulted in death. A jury recommended that Wagoner be sentenced to five years' incarceration. Wagoner owned and operated The Claye Corporation, a group home for adults. The victim was an intellectually disabled adult suffering from Parkinson's disease, and received care in a group home operated by The Claye Corporation. On February 8, 2011, after the victim suffered an episode of incontinence, direct care givers placed him in a bathtub while they cleaned the affected area of the house. The victim was placed under a faucet running scalding water and suffered second- and third-degree burns on his legs, face, buttocks, and arm. Ten days later, he was found dead in his bed with scabbed burns. The medical examiner determined that he died from sepsis and pneumonia secondary to thermal injury. His death was ruled as a direct result of the injuries he sustained on February 8, According to court testimony, the victim s care givers failed to call 911 or the victim's physician, instead claiming to have called the local hospital's emergency room. The care givers claimed to have received instructions to treat the burns with First Aid ointment. However, hospital policy does not allow personnel to give treatment information over the phone. An investigation by the Virginia MFCU revealed that, following the burn incident, the victim's care givers had placed him in a van to transport him to the hospital. However, Wagoner ordered the van to return to the group home. Wagoner then examined the victim s injuries and decided to keep him at the group home instead of providing him with emergency medical treatment.

2 CASES Behavioral Health: Nevada Attorney General Catherine Cortez Masto announced on June 28 that Joseph Lewellyn, an owner of a Medicaid facility, who submitted false Medicaid claims, has been sentenced to 12 to 48 months in jail and ordered to pay $200,000 in restitution, penalties, and costs. Lewellyn was sentenced for two felony offenses of submission of false claims of Medicaid fraud. He was also sentenced to community service and two years of probation. The investigation began after information was obtained that Lewellyn, the owner of Ocean Adult, Child, and Family Services (OACFS), and his employees, were not providing services to Medicaid recipients. Through the operation of OACFS, Lewellyn created or directed the creation of false documentation, which indicated services were provided to Medicaid recipients when in fact the services were not provided. Interviews with Medicaid recipients and former employees of OACFS showed that Lewellyn and his employees were not providing the Behavior Skills Training (BST) and Psychosocial Rehabilitation (PSR) services to Medicaid recipients as indicated on claims submitted to Medicaid. In one instance, claims were submitted for services allegedly provided to a Medicaid recipient when she was incarcerated. Dentists: Ohio For further information contact Senior Deputy Attorney General Andrew Schulke (775) Attorney General Mike DeWine announced on June 26 that Gordon Noakes was found guilty of one count of Medicaid fraud, a misdemeanor of the first degree and was sentenced to pay Investigative costs in the amount of $13,442.52, and a fine of $200. He paid $6, in restitution. A complaint was filed charging Noakes with one count of Medicaid fraud, a misdemeanor of the first degree. Dr. Noakes, a dentist, would take multiple types of x-rays on a single day of service, which meant that Noakes had to bill all the x-rays under one bundled billing code. Noakes would bill each x-ray separately and change the date of service on the submitted claims in order to be paid the individual rate for each x-ray instead of the bundled rate. Dentists: Texas For further information contact Assistant Attorney General William Greene (614) Attorney General Greg Abbott announced on May 16 that Carlos Morales-Ryan, DDS, and wife Nelia Patricia Garcia-Morales, DDS, pleaded guilty in federal court to making false statements regarding a health care reimbursement. Drs. Morales and Garcia, owners of Orthogenesis International Centre, were paid more than $854,000 by Medicaid for services allegedly rendered not by them, but by dental assistants in the office while Morales and Garcia were not in Laredo. 2

3 Attorney General Abbott announced on May 24 that Alonzo Yepez, Jr., former office manager for his sister, Monica Yepez-Villareal, DDS, was indicted by a state grand jury for theft. Yepez allegedly billed Medicaid for services using his sister's Medicaid provider number, which his sister did not provide. For further information on these cases contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Drug Diversion: Texas Attorney General Abbott announced on May 11 that licensed vocational nurse (LVN) Jeanine Waltz received five years of deferred adjudication community supervision and was ordered to pay a $500 fine and complete 120 hours of community services after pleading guilty in state court to possession of a controlled substance by fraud. Waltz allegedly diverted hydrocodone from patients at Bivens Memorial Nursing Home for her own use. Attorney General Abbott announced on June 15 that licensed vocational nurse (LVN) Leigha Jeanne Glass was indicted by a state grand jury for obtaining a controlled substance by fraud. Glass allegedly diverted prescription narcotics from several residents while employed at Gracy Woods Nursing Home. Attorney General Abbott announced on June 19 that licensed vocational nurse (LVN) Leah L. Pierpoint was sentenced in state court to two years of incarceration. She pleaded guilty in April to two counts of fraud by deception. Pierpoint, while employed at Baywind Village Convalescent Center, allegedly wrote discontinued orders for Vicodin for numerous residents and took the medication for her own use. Attorney General Abbott announced on June 27 that care giver Marjorie Mann Bonner received six days in jail and was ordered to pay a $200 fine after pleading guilty in state court to possession of dangerous drugs. Mann allegedly diverted Tramadol from residents of The Good Life Assisted Living for her own use. For further information on these cases contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Durable Medical Equipment: Texas Attorney General Abbott announced on May 2 that Philip Odoemena, owner of Kingsway Medical Systems, Inc., was indicted by a federal grand jury for health care fraud. Odoemena allegedly billed Medicare and Medicaid for enteral nutrition, wheel chairs and incontinence supplies which were not provided or necessary. 3

4 Attorney General Abbott announced on May 2 that Victor Benson Ekpo was indicted by a federal grand jury for conspiracy to commit healthcare fraud and illegal remunerations. Ekpo, owner of Trak DME Corporation, allegedly entered into a kickback scheme with Shavator Shakun Albro and Francis Joseph Ibiok to purchase protected healthcare information from Texas Medicare/ Medicaid recipients and then billed Medicaid and Medicare for orthotics that were never delivered. Albro allegedly used a defunct DME company, Expediate Healthcare Supply, LLC, to bill Medicaid for incontinent supplies not provided. Albro and Ibiok previously pleaded guilty to conspiracy to commit healthcare fraud and illegal remuneration and are awaiting sentencing. The loss to Medicaid is approximately $221,000. Attorney General Abbott announced on May 7 that Okey Fetus Nwagbara, a DME owner, was sentenced in federal court to 36 months each for conspiracy to commit health care fraud, providing a false statement on immigration documents, and unlawful procurement of naturalization. He was ordered to pay $317,779 in restitution. If not deported after his sentence, he will be on supervised release for two years. His certificate of naturalization has been revoked. Nwagbara owned Advanced Medequip & Supplies, Ltd. He allegedly billed Medicaid and Medicare for enteral nutrition feeding supplements and supply kits which were not provided. The Medicaid loss is over $76,200. Attorney General Abbott announced on May 17 that Graciela Reyes De La Garza, owner of Upper Valley DME, biller Ramon Rangel De La Garza, and driver David Sandoval, were indicted by a state grand jury for theft. Upper Valley DME allegedly billed for incontinence supplies which were not delivered. Attorney General Abbott announced on May 24 that Felicitas Alanis was sentenced in federal court to 36 months of incarceration and Erika Ortega Alanis was sentenced to 32 months. Both will be placed on three years of supervision following their release and were ordered to jointly pay $616,390 in restitution. Felicitas Alanis, owner of Vel-Ala, Inc., dba Nisi Medical Supplies and biller Erika Alanis allegedly billed for more products than were delivered. The identified Medicaid fraud is over $573,000. Attorney General Abbott announced on June 12 that Ita Udeobong was sentenced to ten years of probation, and was ordered to pay $30,000 in restitution. He was also sentenced to forfeit any claim to approximately $157,000 on hold with the state s single state agency after pleading guilty in state court to Medicaid fraud, making a false statement, theft, tampering with government records, and money laundering. Udeobong, owner/operator of Midland Care Medical Supplies & Equipment, allegedly billed for incontinence and colostomy supplies that were not delivered or needed. For further information on these cases contact Rick Copeland, Director or Chief Investigator Travis Tucker (512)

5 Attorney General Abbott announced on June 21 that Celestine "Tony" Okwilagwe and Paul Emodi were each given one year of deferred adjudication community supervision and were ordered to pay $4, in restitution after pleading guilty in state court to attempted theft. Okwilagwe, co-owner of South Medical Supply and Equipment, allegedly billed Medicaid for incontinence products that were not delivered. Emordi, an employee, allegedly completed Title XIX authorization letters without the physician's knowledge or consent. Attorney General Abbott announced on June 26 that Marcelo Herrera and Carla Cantu Herrera, owners of RGV-DME, and billers Ramon Rangel De La Garza and Beatriz Adriana Ramos, were indicted by a federal grand jury for conspiracy to commit health care fraud, and multiple counts of health care fraud, fraud by wire, radio or television, and aggravated identity theft. Marcelo Herrera, allegedly billed Medicaid for electric wheelchairs that were not received by the patients. For further information on these cases contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Durable Medical Equipment: Wisconsin Attorney General J.B. Van Hollen announced on June 29 that seven defendants were engaged in a scheme to defraud the Wisconsin Medicaid program by the submission of claims for payment for the provision of durable medical equipment (DME) used for orthotic purposes. Each of the seven had submitted applications to Wisconsin Medicaid to become DME providers, obtained provider numbers and authorization to bill for the DME provided. Claims that followed were primarily for halo cervical devices, tension scoliosis devices, and KAFO devices used to support the knee-anklefoot. That equipment typically requires specialized medical treatment for installation and use, but no such complementary claims from hospitals or physicians were filed. Further investigation revealed that the recipients for whom the devices were allegedly provided did not know the providers, or have need for such orthotic devices. The total amount claimed through such billings was $1,253,816.73, but the Bureau of Public Integrity at the Wisconsin Department of Health Services was able to identify and intercept $199, before it was paid out. Donnis Carrington d/b/a DC Medical Services, was convicted on March 15 of one count of Medicaid fraud. On May 23, the judge imposed and stayed a sentence of three and a half years imprisonment, and placed him on three years of probation with conditions to include six months in the House of Corrections. Ericka Thomas, d/b/a Ericka s Medical Supply, was convicted on April 16 of four counts of Medicaid fraud. On June 7, Judge Cimpl sentenced Thomas to 12 years imprisonment, comprising four years initial confinement and eight years extended supervision. Thomas must pay $356, in restitution to the Wisconsin Medicaid program. On June 28, four more people were sentenced for crimes in a Medicaid fraud scheme. Lynnesha Craig, Wisdom Medical Supply, was convicted on three counts of Medicaid fraud, and was sentenced to a total of nine years of imprisonment, comprising three years of initial confinement and six years of extended 5

6 supervision. Conditions of extended supervision include no contact with any victims, absolute sobriety and payment of $94, in restitution. Darius Jarrett, Great Medical Services, was convicted of three counts of Medicaid fraud. Jarrett was sentenced on the first two counts to a total of six years imprisonment, comprising two years initial confinement and four years of extended supervision; on the third count a sentence of three years and six months of imprisonment was imposed and stayed, and Jarrett was placed on three years of probation consecutive to the first two counts. Conditions of extended supervision and probation include no contact with any victims, full-time employment and payment of $235, in restitution. Elizabeth Thomas, Direct Medical Supply, was convicted on four counts of Medicaid fraud. Thomas was sentenced to a total of 12 years of imprisonment, comprising four years of initial confinement and eight years of extended supervision. Conditions of extended supervision include no contact with any of the victims, obtain an HSED or GED, and payment of $256, in restitution. Kimberly Thomas, Cudahy Medical Supply, was convicted on one count of Medicaid fraud, Her sentence of imprisonment for three years and six months, comprising eighteen months initial confinement and two years of extended supervision, was imposed and stayed. She was placed on three years of probation with conditions to include six months in the House of Corrections, and payment of $28, in restitution. Erica Danley, Essential Services was convicted on April 16 on three counts of Medicaid Fraud and is awaiting sentencing. For further information contact Tom Storm, Director (608) Early Interventionists: South Carolina Attorney General Alan Wilson announced on May 31 that Glenda Yvette Thompson was convicted of one count of filing false claims. On or about October 19, 2005 and continuing to March 1, 2010, Thompson submitted a false employment application misrepresenting that she earned a Bachelor of Science degree in elementary education and is qualified to provide skilled services as an Early Interventionist to Medicaid recipients. This caused her to obtain Medicaid payments to which she was not entitled. Thompson was sentenced to three years suspended upon payment of $ which is the balance of restitution within 30 days. Additionally, the state recovered $2, in restitution. For further information contact Assistant Deputy Attorney General Charles W. Gambrell, Jr., or Chief Investigator Harry Bracy (803) Group Homes: Nevada Attorney General Catherine Cortez Masto announced that a former owner and administrator of a group home facility in Las Vegas has been sentenced to 12 months in jail and ordered to pay $68,249 in restitution, penalties, and costs. Gloria Repollo of Las Vegas, was sentenced on June 27 for one gross misdemeanor offense of exploitation of an older person. Repollo was also sentenced to community service and three years of probation. 6

7 MFCU investigators began looking into the case after information was obtained from the Clark County Public Guardians Office that Repollo, the owner and administrator of Adult Care Senior Home, was financially exploiting one of the residents of the home. The investigation revealed that Repollo was obtaining money from a victim during times that the resident was hospitalized and had been deemed incompetent by a medical professional. For further information contact Senior Deputy Attorney General Andrew Schulke (775) Habilitation Services: New York Attorney General Eric T. Schneiderman announced on June 14 the felony conviction of Seibert Phillips, former Chief Executive Officer of Evelyn Douglin Center for Serving People in Need (EDC) for stealing over $600,000 from the charity. Phillips was arrested and charged with one count of grand larceny in the second degree. He pleaded guilty as charged in Supreme Court. Evelyn Douglin Center is a Medicaid-funded corporation which provides care and services to mentally disabled New York City residents. Among other things, it operates supportive and supervised alternative housing and provides residential habilitation and day habilitation programs for those in need. EDC is reimbursed in part by the New York State Medicaid program. Over a five year period, while Chief Executive of EDC, which he founded in 1999, Phillips secretly diverted over $600,000 in Medicaid checks made payable to EDC into a fraudulent account he opened in the corporation s name. Phillips thereafter used this account for himself, funding frequent personal travel, cars and even his dog trainers. EDC s Board of Directors was unaware of the secret account and cooperated in the investigation leading to Phillips s arrest and conviction. Phillips s arrest and conviction arises out of the Medicaid Fraud Control Unit s prior investigation of EDC which concluded last year with a $5 million settlement. Medicaid rules required EDC to draft and maintain daily reports detailing the specific services it provided to Medicaid recipients. The investigation uncovered that, for a five year period ending in 2009, EDC altogether failed to create many of the records. As part of its settlement agreement, EDC also agreed to reconstitute its Board of Directors and to retain a monitor for five years to ensure its compliance with all applicable Medicaid rules and regulations. Phillips s secret account came to light during the investigation of EDC. Phillips pleaded guilty to grand larceny in the second degree, a class C felony which carries a maximum penalty of five to fifteen years in state prison. Under the terms of his plea agreement, Phillips will be sentenced to five years of probation, pay back restitution totaling $445,000 to EDC, and perform 500 hours of community service. For further information contact Special Assistant Attorney General Twan V. Bounds or Special Auditor Investigator Dorota Gogolowski (212) Hearing Aids: Texas Attorney General Abbott announced on May 23 that Robert R. Sommerville, MD, and Maria Nieto, his medical assistant, were indicted by a state grand jury for theft for billing for hearing aids that allegedly were not dispensed to clients. Dr. Somerville, owner of El Mercado ENT and Allergy, also allegedly paid kickbacks to adult day care owners for allowing him to perform services at their centers. The loss to Medicaid is over $333,000. 7

8 For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) 371 Home Health Care: Idaho Attorney General Lawrence Wasden announced on June 4 that Diana J. Gifford was sentenced on two felony counts of Medicaid provider fraud. Gifford was sentenced to two to five years in prison. The court suspended the prison sentence and ordered Gifford to serve 30 days in the county jail and five years of probation. Gifford also must pay a $500 fine, perform 100 hours of community service and satisfactorily complete drug court. The Medicaid Fraud Control Unit filed a criminal complaint on November 10, 2011, charging Gifford with three counts of Medicaid provider fraud and one count of grand theft. On February 13, Gifford pleaded guilty to two counts of Medicaid provider fraud. Pursuant to a plea agreement, the state dismissed the remaining charges. Medicaid paid Gifford, whose son is a Medicaid recipient, to drive him to medical appointments in Salt Lake City. In late 2007, she began billing Medicaid for trips that did not occur. Between September 2007 and May 2010, Gifford fraudulently billed and was paid by Medicaid for 422 fictitious trips between her home and medical providers in Salt Lake City. These false billings, for 168,800 miles that were not actually travelled, resulted in a $17,224 loss to Medicaid. The court ordered Gifford to pay Idaho Medicaid $17,224 in restitution, along with $3, in prejudgment interest. Gifford also must pay $ for investigative costs. For further information contact Kendal McDevitt, Director (208) Home Health Care: Nevada Attorney General Masto announced on May 14 that Osbel Rodriguez was sentenced for falsely reporting personal care services. Rodriguez provided services as a personal care assistant (PCA) through four agencies, including Addus Healthcare, Alternate Home Series, New Sunset Personal Care, and Las Vegas Healthcare, that contract with Medicaid to provide personal care services to people in their homes. Rodriguez pleaded guilty to a gross misdemeanor offense of intentional failure to maintain an adequate record. Rodriguez was ordered to serve 180 days jail, suspended, and ordered to pay $11,794 in restitution, penalties and costs. In November, 2009, the Medicaid Fraud Control Unit received information that Rodriguez had claimed he provided services to clients who were not actually receiving all of the claimed services. A further investigation by the MFCU revealed that Rodriguez was concurrently employed as a PCA by four PCA agencies and claimed to have simultaneously provided services to multiple clients in different locations. Rodriguez provided this information to the agencies for which he worked and received payment as if he had performed the services. 8

9 For further information contact Senior Deputy Attorney General Matthew Jensen (775) Home Health Care: Ohio Attorney General DeWine announced on May 7 that Latosha Barber pleaded guilty to one count of theft by deception, a misdemeanor of the first degree and was sentenced to a three month suspended jail sentence, two years of probation, and ordered to pay $2, in restitution. On July 19, 2011, an indictment was filed charging Barber with one count of theft by deception, a felony of the fifth degree. Barber was a non-agency home health care aide who billed for services not rendered to three Medicaid recipients. Attorney General DeWine announced on May 10 that Barbara Davis pleaded guilty to one count of theft by deception, a misdemeanor of the first degree and was sentenced to a 30 day suspended jail sentence, a one month probation, and ordered to pay restitution in the amount of $10,000. On March 20, an indictment was filed charging Davis with one count of theft by deception, a felony of the fourth degree. Davis billed for services not rendered. For further information on both cases contact Assistant Attorney General Maritsa Flaherty (614) Attorney General DeWine announced on May 10 that William Harter pleaded guilty to one count of theft, a misdemeanor of the first degree and was sentenced to a 180 day suspended jail sentence, five years of probation, and ordered to pay restitution in the amount of $5, On January 24, an indictment was filed charging Harter with one count of theft, a felony of the fourth degree. Harter billed for services for which he had already been paid by the recipient through patient liability. For further information contact Assistant Attorney General Jon Metzler (614) Attorney General DeWine announced on May 30 that Brenda Simmons pleaded guilty to one count of theft by deception, a misdemeanor of the first degree and was sentenced to a 120 day suspended jail sentence, ordered to pay $5,000 in restitution, and placed on probation for two years. On February 21, an indictment was filed charging Simmons with one count of theft by deception, a felony of the fourth degree. Simmons is a Medicaid recipient that received kickbacks from her provider who billed for services not rendered. 9

10 Attorney General DeWine announced on May 30 that Jeanette Williams-Wood pleaded guilty to one count of theft by deception, a misdemeanor of the first degree and was sentenced to a 120 day suspended jail sentence, ordered to pay restitution in the amount of $4,000, and placed on probation for two years. On February 21, an indictment was filed charging Williams-Wood with one count of complicity to commit theft by deception, a felony of the fourth degree. Wood is a Medicaid recipient that received kickbacks from her provider who billed for services not rendered. Attorney General DeWine announced on May 30 that Takiyah Mathis was sentenced to five years of community control, ordered to serve 30 days at a county correctional center, and ordered to pay $55, in restitution. If the defendant violates community control, she will receive a prison term of 18 months. On March 16, 2010, an indictment was filed charging Mathis with one count of theft, a felony of the fourth degree. On June 7, 2011, Mathis pleaded guilty to one count of theft, a felony of the fourth degree. Mathis was an independent home health care aide who billed for services to four different Medicaid recipients after the recipients fired her. For further information contact Assistant Attorney General William Greene (614) Attorney General DeWine announced on June 4 that Rosemarie Radovanic was sentenced to five years of community control, ordered to pay court costs in the amount of $191 and ordered to pay $261, in restitution. If the defendant violates community control she will receive a prison term of 12 months. On December 21, 2011, an indictment was filed charging Rosemarie Radovanic with one count of theft by deception, a felony of the third degree. On May 21, Radovanic pleaded guilty to one count of theft by deception, a felony of the fourth degree. Radovanic, co-owner of A Caring Alternative, knowingly hired employees with criminal backgrounds who were disqualified from providing services to Medicaid recipients and thus fraudulently billed the Medicaid program for services that should not have been paid. Attorney General DeWine announced on June 6 that A Caring Alternative was found guilty of theft by deception, a felony of the third degree and was sentenced to pay $242, in restitution and to pay a fine of $15,000. On December 21, 2011, an indictment was filed charging A Caring Alternative with one count of theft by deception, a felony of the third degree. A Caring Alternative, through its owners, knowingly hired employees with criminal backgrounds who were disqualified from providing services to Medicaid recipients in violation of the law and deceived ODJFS who would not have paid the claims had they known. 10

11 0722. For further information on both cases contact Assistant Attorney General Maritsa Flaherty (614) 466- Attorney General DeWine announced on June 7 that Virginia Harriman pleaded guilty to one count of theft, a felony of the fifth degree and was sentenced to three years of community control, ordered to pay court costs in an amount to be determined, and to pay $5, in restitution. On May 12, a bill of information was filed charging Harriman with one count of theft, a felony of the fifth degree. Harriman, a home health care aide, billed for services not rendered. For further information contact Assistant Attorney General Constance Nearhood (614) Attorney General DeWine announced on June 15 that Tina Gorby was sentenced to five years of community control. If the defendant violates community control, she will receive a six month prison term. On November 15, 2011, an indictment was filed charging Gorby with one count of theft by deception, a felony of the fourth degree. On May 2, Gorby pleaded guilty to one count of theft by deception, a felony of the fifth degree. Gorby, a home health care aide, billed for services not rendered. Attorney General DeWine announced on June 18 that Fanigan Victor Preston pleaded guilty to one count of theft by deception, a misdemeanor of the first degree and was sentenced to a 180 suspended jail sentence, five years of probation, ordered to pay court costs in an amount to be determined, and ordered to pay $8,109 in restitution. On March 20, an indictment was filed charging Preston with one count of theft by deception, a felony of the fourth degree. Preston was a home health care aide who billed for services not rendered to Medicaid recipient Cynthia Preston. He paid her kickbacks as part of the arrangement. For further information on both cases contact Attorney General Maritsa Flaherty (614) Attorney General DeWine announced on June 18 that Karen McKee pleaded guilty to one count of theft by deception, a misdemeanor of the first degree, and was sentenced to a 180 suspended jail sentence, five years of probation, ordered to pay court costs in an amount to be determined, and ordered to pay $6,000 in restitution. On March 20, an indictment was filed charging McKee with one count of theft by deception, a felony of the fourth degree. McKee was a home health care aide who billed for services not rendered to Medicaid recipient Cynthia Preston. McKee paid her kickbacks as part of the arrangement. McKee also had a convicted sex offender care for Preston but billed under her provider number. 11

12 For further information contact Assistant Attorney General Maritsa Flaherty (614) Attorney General DeWine announced on June 21 that Dominique Lawrence was sentenced to five years of community control, and ordered to pay restitution in the amount of $12, If the defendant violates community control, she will receive a ten month prison term. On October 18, 2011, an indictment was filed charging Lawrence with one count of grand theft, a felony of the fourth degree and one count of falsification in a theft offense, a felony of the fourth degree. On April 30, Lawrence pleaded guilty to one count of falsification, a felony of the fourth degree. Lawrence, a home health care aide, billed for services not rendered. For further information contact Assistant Attorney General Daniel Huston (614) Attorney General DeWine announced on June 26 that Janice Miller pleaded guilty to one count of Medicaid fraud, a misdemeanor of the first degree and was sentenced to a three month suspended jail sentence, and was ordered to pay $4, in restitution. On September 20, 2011, an indictment was filed charging Miller with one count of theft, a felony of the fourth degree, one count of forgery, a felony of the fifth degree, and one count of Medicaid fraud, a felony of the fifth degree. Miller, a Medicaid recipient, knowingly signed false timesheets for her home health provider. For further information contact Assistant Attorney General Jonathan Metzler (614) Home Health Care: Oregon Attorney General John R. Kroger announced on May 2 the conviction and prison sentences of Karyn S. Cunningham and Sheila M. Schaffner for numerous counts of making a false claim for health care payment, criminal mistreatment and theft in the first degree relating to a multi-year fraud, costing the state over $60,000. Since late 2008, Schaffner was paid as a live-in caregiver by Medicaid to care for Cunningham, and both defendants claimed that Cunningham was paralyzed from the waist down, wheelchair bound, and needed assistance in dressing, toileting, and transportation. Cunningham also received subsidized housing and received special accommodation including an extra bedroom due to allegedly being wheelchair bound and needing a live-in caregiver. Cunningham also received food stamps. An investigation by the Medicaid Fraud Control Unit revealed that Cunningham was not wheelchair bound, did not need care, and was seen numerous times driving and fixing her car and even chasing her dog. Cunningham also had a Power of Attorney for her nursing home bound father. The investigation revealed Cunningham failed to pay his nursing home bill and diverted her father s funds to pay for personal expenses. In June 2011 when the two defendants presented at the Department of Human Services local office, surveillance by the MFCU of Cunningham s residence revealed Cunningham walking to her car, but when arriving at the DHS office, Schaffner dutifully unloaded a wheelchair from the car and carefully 12

13 assisted Cunningham into the chair and wheeled her into the office. Cunningham was sentenced to 16 months in prison and Schaffner was sentenced to 13 months in prison, and ordered to repay the state over $66,000 in restitution. For further information contact Senior Assistant Attorney General Sheen Y. Wu (971) Home Health Care: Texas Attorney General Abbott announced on May 16 that Ezinne Ubani was sentenced in federal court to 97 months of incarceration followed by three years of supervised release and was ordered to pay $2.5 million in restitution to Medicare. Eleven subjects in this case were indicted and have either pleaded guilty to or were convicted at trial of multiple counts of conspiracy, health care fraud, paying or receiving kickbacks, and making false statements. Ezinne Ubani, her spouse Clifford Ubani and Caroline and Princewill Njoku allegedly orchestrated the scheme to pay home health nurses and marketers to admit and subsequently re-certify home healthcare patients. Caroline Njoku was sentenced in February to 63 months in prison with one year of supervised release and was ordered to pay $631,295 in restitution to Medicare. The identified fraud amount is approximately $5.1 million. Attorney General Abbott announced on May 24 that Christopher Ogbuehi was given three years of deferred adjudication community supervision and was ordered to pay $3, in restitution and a $1,500 fine after pleading no contest in state court to aggregate theft with contractual relationship with the government. Ogbuehi, owner of Criskel Home Health, allegedly billed for services that were not rendered. Attorney General Abbott announced on June 27 that Deborah De'Nard was indicted by a state grand jury for Medicaid fraud, theft, and securing execution of a document by deception. Caregiver De'Nard allegedly billed for services provided to a client, her son, when the client was incarcerated. Attorney General Abbott announced on June 28 that Ollie Futrell was sentenced in federal court to 33 months in prison with two years of supervised release. He was ordered to pay $853, in restitution to Medicare. Futrell, an employee of Alliance Home Healthcare Services, LLP, and co-owners Ernest and Edith Amadis and George and Agatha Opurum were indicted in February 2011 and subsequently pleaded guilty to conspiracy to commit healthcare fraud. The loss to Medicaid is over $17,000 and more than $836,000 to Medicare for services that were not necessary. 13

14 Attorney General Abbott announced on June 28 that Princewill Njoku was sentenced in federal court to 108 months in prison followed by three years of supervised release and was ordered to pay restitution of $5,167, to Medicare. On June 13, Clifford Ubani was sentenced to 108 months in prison followed by three years of supervised release and was ordered to pay restitution of $4.2 million to Medicare. They were sentenced as a result of their involvement with Family Health Care Services. Njoku, Ubani and their respective wives, Caroline and Ezinne, allegedly orchestrated a scheme to pay home health nurses and marketers for the admission and subsequent re-certification of home healthcare patients. Eleven subjects in this case were indicted and have either pled guilty to or were convicted at trial of multiple counts of conspiracy, health care fraud, paying or receiving kickbacks, and making false statements. The identified fraud amount is approximately $5.1 million. For further information on these cases contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Home Health Care: Vermont Attorney General William H. Sorrell announced on May 16 that Tammy Thomas was convicted in Vermont district court of four misdemeanor counts of false pretenses. The convictions stemmed from Thomas submission of falsified timesheets in order to obtain payment for services that were not provided while she was employed as a personal caregiver under a Vermont Medicaid program. Thomas was sentenced to two to four years in jail, all suspended, and placed on two years of probation subject to standard conditions and a special condition that she not work as a home-based care provider under a Medicaid waiver program. Thomas was also ordered to pay $3,140 in restitution to the Vermont Medicaid program. For further information contact Assistant Attorney General Steven Monde (802) Medical Clinics: Texas Attorney General Abbott announced on June 29 that Kenneth Anokam was sentenced in federal court to 151 months in prison with three years supervised release and was ordered to pay approximately $16 million in restitution to Medicare and $3 million to Medicaid. Anokam was found guilty at trial of conspiracy to commit health care fraud, health care fraud, and structuring to avoid reporting requirement. Codefendant Gwendolyn Frank pleaded guilty on June 19, to conspiracy to receive kickbacks. On June 7, Floyd Brooks also pleaded guilty to conspiracy to receive kickbacks. Anokam was the office manager at City Nursing Services of Texas, a clinic owned and operated by Umawa Imo. Frank and Brooks were marketers for City Nursing and allegedly received kickbacks for referring beneficiaries. City Nursing billed Medicaid and Medicare for physical therapy services which were allegedly not needed and not provided. Three defendants, including City Nursing owner Imo have been sentenced to date, resulting in combined prison time of 508 months and $47 million court ordered restitution For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512)371-14

15 Medical Transportation: Florida Attorney General Pam Bondi announced on May 3 that Edna Iris Torres was charged with defrauding the Florida Medicaid program out of more than $28,000. She was arrested on a felony warrant by the Medicaid Fraud Control Unit and is charged with grand theft and Medicaid fraud, both seconddegree felonies. If convicted, she faces up to 30 years in prison and more than $20,000 in fines. Based on information provided by the Agency for Persons with Disabilities, the MFCU initiated an investigation into Blessed Friends Transportation Services, Inc., a Medicaid home and community-based services provider. The investigation revealed that the defendant submitted fraudulent timesheets to make it appear as if she had provided services to Medicaid recipients. Between May 2007 and February 2011, the Agency for Health Care Administration paid more than $28,000 for these fraudulent claims. For further information contact James D. Varnado, Director (850) or Regional Chief Assistant Attorney General Luis Martinez (305) Medical Transportation: Ohio Attorney General DeWine announced on May 2 that Lisa Jones was sentenced to five years of community control, and ordered to pay $57, in restitution. If the defendant violates community control she will receive an 18 month prison term. On May 17, 2011, an indictment was filed charging Jones with two counts of theft by deception, felonies of the fourth degree. On January 30, Jones pleaded guilty to two counts of theft by deception, felonies of the fourth degree. Jones assisted in the operation of the ambulette business, which didn t provide wheelchair transports when they billed for them. Lisa also assisted her son and husband to bill for Medicaid home health services that were never provided to her. Attorney General DeWine announced on May 2 that Demetrius Jones was sentenced to five years of community control, and ordered to pay $57, in restitution. If the defendant violates community control she will receive an 18 month prison term. On May 17, 2011, an indictment was filed charging Jones with two counts of theft by deception, felonies of the fourth degree. On January 30, Jones pleaded guilty to two counts of theft by deception, felonies of the fourth degree. Jones assisted in the operation of the ambulette business, which didn t provide wheelchair transports when they billed for them. He also assisted Leonte Knowles and Lisa Jones in billing for Medicaid home health services that were not provided. For further information on both cases contact Assistant Attorney General Maritsa Flaherty (614)

16 Attorney General DeWine announced on May 23 that Carolyn Quinnie was sentenced to five years of community control, ordered to pay court costs in an amount to be determined, and ordered to pay restitution in the amount of $70, If the defendant violates community control she will receive a 15 month prison term. On February 15, 2011, an indictment was filed charging Quinnie with one count of theft, a felony of the fourth degree. On February 14, a jury found Quinnie guilty of one count of theft, a felony of the fourth degree. Quinnie as owner of 3 Ease Home Health, an ambulette provider, billed for ambulatory recipients, knowing she could not do that. She also billed for an extra attendant that was never provided. For information contact Assistant Attorney General Constance Nearhood (614) Medical Transportation: Texas Attorney General Abbott announced on May 15 that Caroline Hernandez was sentenced in federal court to five years of probation and was ordered to pay $30, in restitution. She pleaded guilty in January to theft of funds from a health care benefit program. Hernandez was one of seven former state employees and twelve others indicted for health care fraud, theft or embezzlement in connection with health care, and false statements related to health care matters. The former state employees worked for the Medical Transportation Program call center where they allegedly authorized advance payments to be issued to relatives or friends for Medicaid recipients' transportation to medical appointments. The appointments were allegedly never scheduled. The fraud is approximately $200,000. Attorney General Abbott announced on June 14 that Edward Devally pleaded guilty in federal court to theft of funds from a health care benefit program. Seven former state employees and 12 others were indicted for health care fraud, theft or embezzlement in connection with health care, and false statements related to health care matters. The former state employees worked for the Medical Transportation Program call center, where they allegedly authorized advance payments to be issued to relatives or friends for Medicaid recipients transportation to medical appointments. The appointments were allegedly never scheduled. The fraud is approximately $200,000. Attorney General Abbott announced on June 21 that Chantell Williams pleaded guilty in federal court to theft of funds from a health care benefit program. Williams, a former Health and Human Services Commission employee, worked in the Medical Transportation Program (MTP) call center. She allegedly authorized advance payments to be issued to relatives or friends for transportation to medical appointments, when those appointments had not been scheduled and they did not attend those appointments. For further information on these cases contact Rick Copeland, Director or Chief Investigator Travis Tucker (512)

17 Medical Transportation: Wisconsin Attorney General Van Hollen announced on May 1 that Precious Transit, LLC, a specialized medical vehicle transportation company owned by Frederick Rutledge, was convicted of 18 counts of Medicaid fraud. The convictions were based on allegations that drivers for the company were not properly certified as required by Wisconsin Medicaid. Former employees came forward with information that Precious Transit, LLC, falsified paperwork that documented transportation services provided to Medicaid recipients and formed the basis of claims for payment submitted to Wisconsin Medicaid. The documents were falsified to show that drivers who were trained and certified provided the transportation services when, in fact, they did not. The allegations were that the company received approximately $3,000 for trips that were actually provided by non-certified drivers. The company was ordered to pay a $10,000 fine and court costs. Nurses: Ohio For further information contact Assistant Attorney General Jeffrey Gabrysiak Attorney General DeWine announced on June 15 that Yvonnie Day-Booth was sentenced to five years of community control, ordered to pay court costs in an amount to be determined, and ordered to pay restitution in the amount of $75,000. On September 20, 2011, an indictment was filed charging Day-Booth with one count of aggravated theft by deception, a felony of the third degree. On April 30, Day-Booth pleaded guilty to one count of theft by deception, a felony of the fourth degree. Day-Booth, an LPN, billed for services not rendered. She paid the mother of the Medicaid recipient $75 a day to find a babysitter for the child. For further information contact Assistant Attorney General Maritsa Flaherty (614) Nurses: Wisconsin Attorney General Van Hollen announced on April 27 that John V. Wheeler has been sentenced for Medicaid fraud, a felony. Wheeler was placed on three years of probation. As conditions of probation, Wheeler was ordered to serve six months in the county jail, participate in drug and alcohol treatment, pay court costs, and pay $14, in restitution. On April 27, Wheeler entered a plea of guilty to Medicaid fraud, which stems from his employment as a registered nurse for which he submitted fraudulent claims to the Wisconsin Medicaid program. According to the Department of Justice s criminal complaint, Wheeler was employed by Nurses in Independent Practice as a private duty nurse. Wheeler submitted timesheets indicating between March 8, 2010, and October 4, 2010, that he had provided medical services to clients he was assigned to care for when in fact he had not provided those services. Wheeler was paid $14, for those hours he claimed to have worked as a private duty nurse. For further information contact Assistant Attorney General Jeffrey Gabrysiak (608)

18 Nursing Homes: Texas Attorney General Abbott announced on June 25 that Kelvin Washington was sentenced in federal court to 24 months in a Bureau of Prisons medical facility, followed by 12 months of home confinement. He was ordered to pay $80, in restitution to Medicaid and $406,000 to Medicare. Washington was convicted in December 2011 of conspiracy to commit health care fraud, three counts of violation of the antikickback statute and six counts of health care fraud. As the former administrator for Sugar Land Health Care Center, Washington allegedly accepted payment from the owners of Americare Ambulance Service in return for certificates of medical necessity signed by his nursing home staff physicians and for patient referrals to Americare. Americare was an ambulance company originally operated by brothers Raed Elmasri and Murad Almasri and Ayad Fallah. Americare allegedly billed for non-emergency transportation for dialysis patients who did not meet the Medicaid/Medicare guidelines for such transport. During the course of the investigation, the three owners sold the company to brothers Mazen Abdallah and Wesam Abdallah who continued to engage in the same activities which brought the company under investigation. In May 2008, Mazen Abdallah was found guilty of conspiracy to commit health care fraud and sentenced to 30 months of incarceration. Wesam Abdallah was found guilty of conspiracy to commit health care fraud, four counts of health care fraud, and violation of the anti-kickback statute and was sentenced to 30 months of incarceration. The Abdallahs were held jointly liable for $637,000 in restitution. Co-defendants Ayad Fallah and Murad Almasri pleaded guilty to conspiracy to commit health care fraud and were each sentenced to 19 months of incarceration and were held jointly liable for $1.6 million in restitution. Codefendant Raed Elmasri remains a fugitive. The identified overpayment was approximately $588,000 for Medicaid and approximately $4 million for Medicare For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) 371- Patient Trust Funds: Florida Attorney General Bondi announced on June 15 that Zonia Cooper was arrested following an investigation by the Medicaid Fraud Control Unit into allegations that the former group home manager exploited eleven disabled adults. Cooper committed the alleged acts of exploitation during her employment at an Arc of Alachua Group Home. According to the investigation, Cooper misappropriated more than $1,300 from eleven disabled adults under her supervision. Cooper has been charged with eleven counts of exploitation of a disabled adult and one count of scheme to defraud, all third degree felonies. For further information contact James D. Varnado, Director (850) or Regional Chief Assistant Attorney General Betty Zachem (850) Pharmacies: Texas Attorney General Abbott announced on May 2 that Peter Ayika, owner/sole operator of Continental Pharmacy, was sentenced to 63 months of incarceration and ordered to pay $2.5 million in restitution after pleading guilty in federal court to health care fraud. 18

19 Ayika allegedly billed Medicare, Medicaid and private insurance companies for controlled substances and selling them to street users. His sentence will run concurrently with the 170-month sentence he received for his previous conviction on two counts of drug distribution. The identified Medicaid fraud is over $700,000. For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Physicians: South Carolina Attorney General Wilson announced on February 14 that Dr. Charles F. Way was convicted of one count of filing false claims. On or about April 28, 2008, Dr. Way caused a false claim for reimbursement to be filed with the South Carolina Medicaid Program. Dr. Way billed for office visits, test and procedures for Medicaid beneficiaries who were hospitalized at the time the procedures, tests, etc. were billed. Dr. Way was sentenced to three years and $1,000 suspended to five years probation with 100 hours of community service and PTUP. Additionally, the state recovered $17, in restitution. For further information contact Assistant Deputy Attorney General Charles W. Gambrell, Jr., or Investigator Chris Radcliff (803) Physicians: Texas Attorney General Abbott announced on May 17 that Donald Gibson II, MD, and Sunday Joseph Edem were indicted by a federal grand jury for conspiracy to commit healthcare fraud and multiple counts of health care fraud. Dr. Gibson allegedly billed Medicaid and Medicare for office visits and signed orders for supplies which were not needed and/or not provided. This billing was done at one or more clinics operated by Edem, who was previously convicted of health care fraud and allegedly owns a controlling interest in several medical clinics that bill Medicaid and Medicare. Attorney General Abbott announced on May 25 that Tina Collins, MD, was sentenced in federal court to 24 months of incarceration with two years supervised release, and was ordered to pay $1,894,938 in restitution to Medicare and $258,893 to Medicaid. Cassandra Tasby and Melloneen Davis were each sentenced on May 11, in federal court in Houston to 36 months probation with four months home confinement and were ordered to jointly and severally pay $42, in restitution to Medicare and $8, to Medicaid. Davis pleaded guilty in December 2011 to conspiracy to commit health care fraud. Tasby and codefendant Dr. Collins pleaded guilty in October 2011 to conspiracy to commit health care fraud. Robert Baker, a marketer who was allegedly paid to bring patients to the clinic, was indicted on May 2 for violation of the anti-kickback statute. Dr. Collins, owner and operator of Adom Rehabilitation and Physical Medicine, and employees Davis and Tasby, allegedly billed Medicaid for services which were not rendered and paid patients to attend her clinic and allow their Medicaid and Medicare identification numbers to be billed. The identified fraud is over $1.3 million. 19

20 Attorney General Abbott announced on June 14 that Ben Echols, MD, was indicted by a federal grand jury in a superseding indictment for conspiracy to commit health care fraud and six counts of false statements relating to health care matters. In May, a jury found Dr. Echols not guilty on three counts of health care fraud and was hung on a conspiracy charge and four counts of health care fraud. Echols was indicted for his alleged involvement with Family Health Care Services, a home health and durable medical equipment company. Echols allegedly accepted money in return for signing orders for durable medical equipment and home health services without regard to medical necessity. To date, 11 individuals involved with the Family Health Care investigation have either pleaded guilty or been convicted and approximately $5.1 million has been identified in overpayments. For further information on these cases contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Podiatrists: Texas Attorney General Abbott announced on May 10 that Shannon Lee Gallentine, DPM, owner of Ambulatory Foot Care, pleaded guilty in federal court to health care fraud. Gallentine was indicted for services not rendered, including services billed for dead beneficiaries. The Medicaid loss is over $110, For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) 371- Resident Abuse: Colorado Attorney General John Suthers announced on June 25 that Lee Virgil Morgan pleaded guilty to theft of medical records, a class 6 felony and theft under $500, a class 2 misdemeanor. On count of theft of medical records, he received a deferred judgment with 24 hours of useful public service, $1,000 fine and four years of supervised probation and court costs. On the count of theft under $500, he received a $250 fine, 24 hours of useful public service, four years of supervised probation, no jail time, and court costs and fees. The remaining count was dismissed. Morgan must report his convictions to the Department of Regulatory Agencies (DORA). The conviction stemmed from Morgan s abuse of a resident at a nursing home Vista View Care Center. Morgan took the personal belongings of a quadriplegic resident and upon being caught and fired he stole the medical records of the same resident. For further information contact Joe DeAngelo, Criminal Investigator (303) or Assistant Attorney General Richard Ferro (303) Resident Abuse: Florida Attorney General Bondi announced on June 29 that a licensed practical nurse at Florida State Hospital was arrested and charged with one count of abuse of a disabled adult at the facility. Melody A. Melton was arrested on a felony warrant by the Medicaid Fraud Control Unit. The investigation revealed that Melton struck a disabled woman at the mental health facility. 20