MEDICAID FRAUD REPORT

Transcription

1 MEDICAID FRAUD REPORT National Association of Medicaid Fraud Control Units July/August 2012 INSIDE Home Health Care Owner Convicted for Defrauding D.C. Medicaid Program... 1 Cases... 2 Case Updates Home Health Care Owner Convicted for Defrauding D.C. Medicaid Program The District of Columbia Medicaid Fraud Control Unit announced on July 13 that Jacqueline Wheeler, the Chief Executive Officer and owner of two health care companies, was convicted by a federal jury of one count of health care fraud and 34 counts of false statements for submitting more than $7 million in fraudulent claims to the D.C. Medicaid program. Wheeler was convicted following a trial in the U.S. District Court for the District of Columbia. She faces a maximum sentence of 10 years in prison and a $250,000 fine for the health care fraud conviction and five years in prison and a $250,000 fine for each of the false statements convictions. The judge ordered that Wheeler be jailed pending sentencing. According to the government s evidence, Wheeler was the chief executive officer of the Health Advocacy Center, Inc. She was also the owner of Sheridan Rehabilitative and Wellness Centers, Inc., a private company located at the same address. Beginning in January 2006 and continuing through April 2008, Wheeler, through the Health Advocacy Center, submitted false claims for services that were not provided. She collected at least $2.6 million before the activities were detected. Evidence showed that she used the proceeds of her fraud to support the purchase of four luxury vehicles, two beachfront properties in Florida, and her home. The Health Advocacy Center was purportedly engaged in serving as an advocate for improved health care delivery to the community. Specifically, it provided management support, as well as financial advice and assistance to other health care providers. It was a registered District of Columbia Medicaid provider. Sheridan Rehabilitative and Wellness Centers was purportedly engaged in providing rehabilitative services to the mentally and physically disabled community, offering housing to mentally and physically challenged individuals.

2 The company was not an authorized D.C. Medicaid provider. Wheeler was a registered naturopath with the District of Columbia Department of Health, Health Professional Licensing Administration. However, she was not a licensed medical doctor. Wheeler did work with a licensed medical doctor, who was a part-owner of the Health Advocacy Center. This doctor s specialty was physical medicine and rehabilitation. As a result of Sheridan Rehabilitative and Wellness Centers not being authorized as a D.C. Medicaid provider, it was unable to submit bills to D.C. Medicaid. From January 2006 through April 2008, Wheeler prepared and submitted all of the billing for the Health Advocacy Center, and handled all financial matters for both the Health Advocacy Center and Sheridan. During that time period, Wheeler submitted over 600 claims to D.C. Medicaid for manual therapy services that the Health Advocacy Center purportedly provided to approximately 22 District of Columbia Medicaid beneficiaries. In these claims, she maintained that the Health Advocacy Center provided in excess of 20 continuous hours of manual therapy for each patient in a single 24- hour period, and sought over $6.5 million from D.C. Medicaid for manual therapy services. In performing therapeutic procedures such as manual therapy, the health care provider is required to bill in 15-minute intervals or units. There are only 1,440 minutes in a day. However, Wheeler routinely billed D.C. Medicaid from 1,440 continuous minutes of manual therapy for a single patient in a 24-hour period to as many as 2,910 continuous minutes (or 48.5 hours) of manual therapy for a single patient in a 24-hour period. D.C. Medicaid paid the Health Advocacy Center in excess of $2.5 million for manual therapy services that were not provided to the patients. The payments were deposited in bank accounts controlled by Wheeler For further information contact Special Assistant U.S. Attorney Dangkhoa Nguyen (202) 727- CASES Counselors: Texas Attorney General Greg Abbott announced on August 15 that licensed professional counselor (LPC) James Edward Williams, was indicted by a state grand jury for Medicaid fraud and theft. Williams, owner of Metropolitan Center for Counseling and Psychotherapy in Fort Worth, Texas, allegedly billed Medicaid for services not rendered, which included billing for services provided by unlicensed personnel. For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Dentists: New York Attorney General Eric T. Schneiderman announced on August 13 that Lawrence J. Bruckner pleaded guilty to failing to pay taxes on payments he received from other dentists who worked at his clinics. Bruckner will pay nearly $700,000 in restitution and will receive a multi-year prison sentence as a result. Bruckner will pay restitution of $559,424 to the Medicaid Program and $121,912 to the New 2

3 York State Department of Taxation and Finance prior to sentencing. Bruckner has agreed to be sentenced to a period of one to three years in state prison. He and his business also face a mandatory minimum five-year suspension from participation in the Medicaid and Medicare programs. From 2007 to 2011, Bruckner, Premier Dental, and three other dentists were paid approximately $6.3 million by New York State s Medicaid program for dental services allegedly performed at Bruckner s offices. Following the pleas, the Attorney General s and Comptroller s offices will continue to investigate violations of the New York State False Claims Act by Bruckner and his co-conspirators and may seek civil monetary recoveries from all of these dentists. Under the False Claims Act, violators can be forced to pay up to three times the amount of the loss to the Medicaid program and up to $12,000 per false claim. Criminal investigations of the other dentists who worked at Bruckner s offices are ongoing and more arrests are possible. For further information contact Special Assistant Attorney Generals Laura J. Meehan or Christopher Y. Miller (212) Dentists: Texas Attorney General Abbott announced on August 15 that Michael D. Goodwin, DDS, was indicted by a federal grand jury on 11 counts of health care fraud. Dr. Goodwin allegedly billed for services provided by dental assistants who were practicing dentistry without a dental license while he was out of state and no other dentist was on the premises. Dr. Goodwin also owns and operates a dental practice in Indiana. The Medicaid overpayment is over $1.9 million. For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Drug Diversion: New York Attorney General Schneiderman announced on August 15 that five arrests were made in a major narcotics trafficking scheme on Staten Island. An investigation revealed that Michael A. Mancusi supplied his drug-dealing operation by allegedly fraudulently claiming serious and permanent injuries related to motor vehicle accidents, and then applying for Social Security Disability Insurance, Medicaid and Medicare benefits to unlawfully obtain prescription drugs, including oxycodone, alprazolam (commonly known as Xanax and fentanyl patches. Together with his girlfriend, co-defendant Shannon Daniell, and other co-conspirators, the Mancusi Organization then illegally sold the drugs to buyers throughout New York City and Long Island. 3

4 The felony complaint charges Mancusi with operating as a major trafficker; criminal possession of a controlled substance in the first degree; criminal possession of a controlled substance in the second degree; criminal sale of a controlled substance in the second degree; attempted criminal sale of a controlled substance in the second degree; insurance fraud in the second degree; grand larceny in the second degree; grand larceny in the third degree; scheme to defraud in the first degree; conspiracy in the fourth degree; and criminal diversion of prescription medication and prescriptions in the fourth degree, among other crimes. Daniell is charged with criminal possession of a controlled substance in the first degree; criminal possession of a controlled substance in the second degree; criminal sale of a controlled substance in the second degree; attempted criminal sale of a controlled substance in the second degree; conspiracy in the fourth degree, and criminal diversion of prescription medications and prescriptions in the fourth degree. In separate felony complaints three additional defendants were charged. Defendant Daniell s mother, defendant Nancy Rivera-Daniell, is charged with attempted criminal sale of a controlled substance in the fifth degree, conspiracy in the fifth degree and attempted criminal diversion of prescription medication in the fourth degree. Ryan Leuchau is charged with criminal possession of a controlled substance in the second degree, attempted criminal possession of a controlled substance in the third degree and conspiracy in the fourth degree, among other charges. Alixandra Bujka is charged with criminal possession of a controlled substance in the seventh degree and conspiracy in the fifth degree. If convicted, Mancusi and Daniell each face a maximum sentence of 20 years in prison. Leuchau faces a maximum sentence of nine years in prison, and Rivera-Daniell faces a maximum sentence of one and a half years in prison. For further information contact Special Deputy Attorney General Monica Hickey-Martin (212) Drug Diversion: Texas Attorney General Abbott announced on July 16 that Therese Marie D Olivera entered a oneyear pre-trial diversion agreement. D Olivera was indicted in December 2011 for obtaining a controlled substance by fraud. While employed by Hearne Healthcare Center, D Olivera, a registered nurse allegedly misappropriated morphine which had been prescribed to a facility resident. Attorney General Abbott announced on July 19 that pharmacist Lisa Lyn Hollier, Dr. Nicolas Padron, and Jose Lazaros Martinez, an employee of Dr. Padron, were indicted for conspiracy to distribute controlled substances. Dr. Padron, through Padron Wellness Clinic and Martinez allegedly distributed controlled substances via prescription without a legitimate medical purpose through Hollier of Urban Independent Pharmacy. 4

5 Attorney General Abbott announced on July 26, Carol Lynn Carr, a registered nurse was indicted by a state grand jury for fraud and for fraudulent use of identifying information. Carr allegedly obtained hydrocodone by fraud from a pharmacy in Athens while she was employed as an RN at Renaissance Hospital in Terrell, Texas. Attorney General Abbott announced on August 10, that licensed vocational nurse Nicole Contreras accepted a 15-month pretrial diversion. She was indicted by a state grand jury in January 2012 for fraud. Contreras, while working at the Lubbock Health Care Center in Lubbock, Texas, allegedly stole narcotics from the facility medication cart. For further information about these cases contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Durable Medical Equipment: Nevada Attorney General Catherine Cortez Masto announced on July 3 that Marcia Giller was sentenced for two felony offenses of submission of false Medicaid claims. The judge sentenced Giller to consecutive terms of 18 to 48 months of imprisonment for each count, and additionally ordered Giller to pay $226,000 in restitution, penalties and costs. In December 2009, the Nevada Medicaid agency provided information to the Medicaid Fraud Control Unit that AME Home Health Care (AME), a medical equipment company owned and operated by Giller, had submitted and been paid Medicaid claims that were not supported by required documentation. A further investigation by the MFCU revealed that, in addition to the lack of supporting documentation, Giller repeatedly submitted claims for persons who did not actually receive supplies from AME. Giller nonetheless continued to submit fraudulent claims and receive payment over the course of several years. Although Giller submitted claims under supposed client names and numbers, those persons were unaware that their Medicaid information was being used in such a way. The fraud occurred from January 2007 through May For further information contact Senior Deputy Attorney General Matthew Jensen (775) 684- Durable Medical Equipment: Ohio Attorney General DeWine announced on August 7 that Willie Johnson was sentenced to five years of community control, ordered to pay court costs in an amount to be determined, and ordered to pay $137,920 in restitution. 5

6 If Johnson violates community control he will receive a prison term of 17 months. Johnson owned a transportation company and billed for ambulatory recipients and services not rendered. For further information contact Assistant Attorney General William Greene (614) Durable Medical Equipment: Texas Attorney General Abbott announced on July 10 that Arthur Johnson pleaded guilty to theft and was sentenced to ten years of probation, and ordered to pay restitution in the amount of $165,888. Arthur and Stephanie Johnson, co-owners of TOPS Medical Supply, were indicted in March 2011 for allegedly billing Medicaid for incontinence supplies that were not delivered. The identified fraud is over $160,000. Attorney General Abbott announced on July 11 that LaTonya Jones and Andtrica Shavelle Howard pleaded guilty to theft with government contractor enhancements and were each given ten years of deferred adjudication community supervision and ordered to jointly and severally pay $31,000 in restitution. Jones and Howard, owners and operators of Respiratory and Oxygen Plus, billed Medicaid for incontinence supplies that were not delivered or only partially delivered. Attorney General Abbott announced on July 20 that Joneshia Lashone Cranford pleaded guilty in federal court to wrongful disclosure of individually identifiable health information. Cranford sold Medicaid and Medicare recipient information to Shavator Shakum Albro and Francis Joseph Ibiok. Albro used a closed DME company, Expediate Healthcare Supply, LLC to bill Medicaid for incontinent supplies not provided. Albro and Ibiok allegedly entered into a kick-back scheme with Victor Benson Ekpo to purchase protected healthcare information. Ekpo then allegedly billed Medicaid and Medicare through Trak DME Corporation for orthotics that was never delivered. Albro and Ibiok pleaded guilty to conspiracy to commit healthcare fraud and illegal remuneration and are awaiting sentencing. Ekpo was indicted for conspiracy to commit healthcare fraud and illegal remunerations and is awaiting trial. The Medicaid overpayment is over $221,000. Attorney General Abbott announced on July 25 that Alex Shittu was indicted by a federal grand jury for conspiracy to commit health care fraud, health care fraud, wire fraud, and aggravated identity theft. Shittu, owner of S & S Medical Supply, Etc. in Stafford, Texas, allegedly billed for incontinence 6

7 supplies, ortho kits, and power wheelchairs that were not needed and/or not provided. Attorney General Abbott announced on July 25 that Clifford Ubani and Princewill Njoku were each sentenced in federal court to 87 months in prison with three years of supervised release. Ubani and Njoku were also ordered to pay $566, in restitution to Medicare. Both previously pleaded guilty to conspiracy to commit healthcare fraud. Njoku and Ubani, who owned Family Healthcare Services in Houston, Texas, with their wives, were indicted with four others for their roles in an alleged scheme to bill the accounts of Medicare beneficiaries for orthotic kits which they did not receive. Anna Quinteros and Rolandae Straughter pleaded guilty to conspiracy to commit health care fraud. Quinteros was sentenced to three years of probation and ordered to pay $122, in restitution to Medicare. Straughter was sentenced to 18 months in prison with three years of supervised release and was ordered to pay $501, in restitution to Medicare. Michelle Turner was convicted of conspiracy to commit health care fraud, conspiracy to receive kickbacks, and receipt of kickbacks. Her sentencing is pending. Mary Lee Ellis was found not guilty at trial, but was convicted in a related case. The identified overpayment is over $465,000. Attorney General Abbott announced on August 1 that Sunday Adebisi was indicted by a federal grand jury for conspiracy to commit health care fraud, health care fraud and aggravated identity theft. Adebisi, owner of Ace Medical Supply and Accessories in Houston, Texas, allegedly billed Medicaid and Medicare for medical equipment that was never properly prescribed by a physician and sometimes never delivered to recipients. The Medicaid overpayment is approximately $4,000, and the Medicare overpayment is approximately $855,000. Attorney General Abbott announced on August 13 that Jose Trinidad Molina pleaded guilty in state court to Medicaid fraud and fraudulent use of identifying information. Molina is the owner/ operator of Priority Care of America (PCA), a durable medical equipment company in San Antonio, Texas. PCA allegedly billed Medicaid and Medicare for diabetic supplies that were not delivered, for deceased clients, and for products that PCA did not purchase. The suspected Medicaid and Medicare overpayments are over $840,000 and $41,000 respectively. 7

8 Attorney General Abbott announced on August 16 that Shavator Shakun Albro was sentenced in federal court to 180 days of home confinement, 15 weekends in jail, 60 months of probation, and was ordered to pay $221, in forfeiture and restitution. Albro pleaded guilty in August 2011 to conspiracy to commit healthcare fraud and illegal remuneration. Albro allegedly used a closed DME company, Expediate Healthcare Supply, LLC, in Lufkin, Texas, to bill Medicaid for incontinent supplies not provided. Albro and Francis Joseph Ibiok allegedly used recipient information supplied by Joneshia Lashone Cranford while Cranford worked as a licensed vocational nurse. Ibiok and Cranford pleaded guilty in federal court and are awaiting sentencing. The Medicaid overpayment is over $221,000. Attorney General Abbott announced on August 30 that Prince Nnamadi Oji was sentenced in federal court to 57 months of incarceration and was ordered to pay $576, in restitution. Oji will be deported upon completion of his sentence. Oji, owner of Florida Boulevard Medical Supply in Lake Charles, Louisiana, pleaded guilty in January 2012 to money laundering. He allegedly bought and sold many of the patient files identified in a related investigation of Matrix Medical Equipment & Supply in Weirton, West Virginia. Matrix owner Jasper Amadi Ogbonna was involved in a scheme to bill for durable medical equipment that was allegedly never properly prescribed by a physician. Matrix was paid approximately $845,000 by Medicare but all Medicaid claims were denied. Of the ten co-conspirators in the case, nine have been convicted and sentenced; one remains a fugitive. For further information about these cases contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Home Health Care: Ohio Attorney General DeWine announced on July 16 that Paula Langhorn pleaded guilty to one count of theft by deception, a misdemeanor of the first degree, and was sentenced to a 180 day suspended jail sentence, two years probation, and ordered to pay restitution in the amount of $6,000. On February 21, an indictment was filed charging Langhorn with one count of complicity to commit theft by deception, a felony of the fourth degree. Langhorn, a Medicaid recipient was involved in kickback scheme with her provider For further information contact Assistant Attorney General Maritsa Flaherty (614) 466-8

9 Attorney General DeWine announced on July 19 that Rebecca Green pleaded guilty to three counts of theft in office, felonies of the third degree, and two counts of tampering with records. Green was sentenced to four years in prison, three years of adult parole, and ordered to pay restitution in the amount of $146, On April 13, an indictment was filed charging Green with six counts of theft in office, all felonies of the third degree, eight counts of theft, all felonies of the fourth degree, and five counts of tampering with records, all felonies of the third degree. Green was a supervisor with the Warren County Department of Human Services and falsified, altered, or destroyed governmental paper and computer records to accomplish theft of benefits. For further information contact Assistant Attorney General Nathan Smith (614) Attorney General DeWine announced on August 1, Jade Mihelarakis pleaded guilty to one count of Theft, a felony of the fifth degree and was sentenced to five years of community control, ordered to pay court costs in the amount of $116, and ordered to pay $22, in restitution. If Mihelarakis violates community control she will receive a ten month prison term. Mihelarakis, an independent provider, billed for services not rendered. Attorney General DeWine announced on August 20 that Megan McGuire pleaded guilty to one count of falsification, a misdemeanor of the first degree, and was sentenced to a 30 day jail term which will be suspended for full payment of $1, in restitution. McGuire, an independent provider, billed for services not rendered. Attorney General DeWine announced on August 29 that Shannon Jackson pleaded guilty to one count of theft, a felony of the fifth degree, and was sentenced to five years of community control, and ordered to pay $10, in restitution. Jackson, an independent provider, engaged in a kickback scheme with the recipient to bill for services not rendered. For further information about these cases contact Assistant Attorney General Jon Metzler at (614)

10 Home Health Care: Texas Attorney General Abbott announced on July 26 that Jerry Ngozika Anyaehie pleaded guilty in state court to aggravated theft. Anyaehie was the director for JEMAK Multi-Services Clinic, Inc., a family and individual counseling clinic, and an owner/operator of Sunrise Clinic and Rehabilitation Services, Inc., a chemical dependency therapy company, both in Houston, Texas. JEMAK allegedly billed Medicaid for counseling that was not provided and sunrise allegedly billed Medicaid for services not rendered for chemical dependency counseling of recipients who do not have a chemical dependency. The overpayment to JEMAK and sunrise is over $383,000. For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Home Health Care Agencies: Texas Attorney General Abbott announced on August 30 that Roger Duane Blaker pleaded guilty in state court to theft. Blaker is a former employee of Champion Care, Inc., a home health agency based in Laredo, Texas, with offices in Corpus Christi, Texas. He was indicted for allegedly submitting time sheets for recipients for whom services were never provided. The identified Medicaid overpayment is approximately $44,000. For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Home Health Care Aides: Ohio Attorney General DeWine announced on July 3 that Jeremy Cunningham pleaded guilty to one count of theft, a misdemeanor of the first degree, and was sentenced to a 120 day suspended jail sentence, one year of probation, and ordered to pay restitution in the amount of $2,625. On April 17, an indictment was filed charging Cunningham with one count of theft, a felony of the fifth degree, and one count of falsification in a theft offense, a felony of the fifth degree. Cunningham, an independent home health care aide, billed for services not rendered For further information contact Assistant Attorney General Constance Nearhood (614) 466- Attorney General DeWine announced on July 6 that Marlon Watson pleaded to one count of theft, a felony of the fourth degree and was sentenced to five years of community control, and ordered to pay restitution in the amount of $35,000. If Watson violates community control he will receive a 12 month prison sentence. 10

11 On August 17, an indictment was filed charging Watson with one count of theft, a felony of the fourth degree. Watson, an agency home health care aide, billed for services not rendered. For further information contact Assistant Attorney General Benjamin Sigall (614) Attorney General DeWine announced on July 18 that Nicole Douds pleaded guilty to one count of theft, a felony of the fourth degree and 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 $35,000. If Douds violates community control she will receive a 12 month prison sentence. On January 24, an indictment was filed charging Douds with one count of theft, a felony of the fourth degree, and one count of falsification in a theft offense, a felony of the fourth degree. Douds, an independent home health aide, billed for services that she did not provide For further information contact Assistant Attorney General Constance Nearhood (614) 466- Attorney General DeWine announced on July 26 that Jina Miller pleaded guilty to one count of Medicaid Fraud, a felony of the fifth degree and 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 $15,000. If Miller violates community control she will receive a 12 month prison sentence. On September 20, 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 home health aide, billed for services not rendered. Attorney General DeWine announced on July 31 that Tracey Campbell pleaded guilty to one count of theft, a misdemeanor of the first degree and was sentenced to a 30 day suspended jail sentence, six months of community control, ordered to pay restitution in the amount of $ On May 15, an indictment was filed charging Campbell with one count of theft, a felony of the fifth degree, one count of falsification in a theft offense, a felony of the fifth degree, and one count of forgery, a felony of the fifth degree. Campbell, a home health aide, billed for services not rendered. 11

12 For further information on these cases contact Assistant Attorney General Jonathon Metzler (614) Attorney General DeWine announced on August 8 that Brandi Santiago pleaded guilty to one count of theft by deception, a misdemeanor of the first degree, and was sentenced to a 180 day suspended jail term, five years of probation, ordered to pay court costs in an amount to be determined, and ordered to pay $5, in restitution. Santiago, home health aide, billed for services not rendered and was involved in a kickback scheme with a recipient. Attorney General DeWine announced on August 8 that Charles Preston pleaded guilty to one count of theft, a felony of the fifth degree and was sentenced to five years of community control, ordered to pay court costs in an amount to be determined, and ordered to pay $3,000 in restitution. If Preston violates community control he will receive a prison term of 11 months. Preston was convicted of rape which makes him ineligible to be a home health aide. Preston had his girlfriend; a home health aide, bill for services allegedly provided to his sister Cynthia Preston and then split the money between Charles and Cynthia. For further information on both cases contact Assistant Attorney General Maritsa Flaherty (614) Attorney General DeWine announced on August 20 that Chante Kerby pleaded guilty to one count of attempted theft, a misdemeanor of the first degree, and was sentenced to a 180 day suspended jail term, three years of probation, and ordered to pay $5, in restitution. Kerby, a home health aide, billed for services not rendered. Attorney General DeWine announced on August 22 that Kendra Lesley 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 was ordered to pay $7,500 in restitution. If Lesley violates community control, she will receive a 12 month prison term. Lesley, a home health aide, billed for services not rendered. Attorney General DeWine announced on August 27 that LaTosha Martin pleaded guilty to one count of theft, a misdemeanor of the first degree, and was sentenced to a 180 day suspended jail term, four years of probation, and ordered to pay $2, in restitution.

13 Martin, a home health aide, billed for services not rendered. For further information on these cases contact Assistant Attorney General Daniel Huston (614) Attorney General DeWine announced on August 30 that Brenda Senter pleaded guilty to one count of theft by deception, a felony of the fifth degree, and was sentenced to three years of community control, and ordered to pay $2,500 in restitution. If Senter violates community control she will receive a six month prison term. Senter, a Medicaid recipient, made false allegations of fraud against her home health aides when they refused to assist Senter in committing Medicaid fraud For further information contact Assistant Attorney General Maritsa Flaherty (614) 466- Medical Transportation: Ohio Attorney General DeWine announced on July 12 that Paulette Lee pleaded guilty to one count of theft, a felony of the fourth degree and was sentenced to three years of community control, ordered to pay court costs in an amount to be determined, and ordered to pay restitution in the amount of $10,000. If Lee violates community control she will receive an 11 month prison sentence. On September 20, an indictment was filed charging Lee with one count of theft, a felony of the fourth degree. Lee, an independent provider, billed for services not rendered For further information contact Assistant Attorney General William Greene (614) 466- Attorney General DeWine announced on August 2 that Delmarr Calhoun was sentenced to six months of house arrest, two years of probation, ordered to pay a $100 special assessment, and ordered to pay $143,070 in restitution. Calhoun, owner of DOC Transportation, billed for ambulatory recipients For further information contact Assistant Attorney General Constance Nearhood (614) 466 Mental Health Centers: Texas Attorney General Abbott announced on July 24, that Shokoufeh Coste Hakimi, Sharonda Denise Holmes, Shawn Eric Manney, Adam William Main and, Terry Wade Moore were indicted for conspiracy to commit health care fraud, health care fraud and health care kickback violations. 13

14 They were employees of Spectrum Care PA, a community mental health center. Spectrum owners Cyrus Sajadi, MD, and Mansour Sanjar, MD, and employee Chandra Nunn, were indicted in December 2011, also for conspiracy to commit health care fraud, health care fraud and health care kickback. Spectrum allegedly billed for services not rendered and paid kickbacks to ambulance companies and individuals who supply patients. Hakimi, Spectrum's office manager, allegedly paid kickback payments to ambulance companies and individuals who supplied patients. Holmes, Manney and Nunn, recruiters for Spectrum, allegedly received kickback payments from Hakimi. Main, a physician assistant, and Moore, a licensed clinical social worker, allegedly were involved in the billing for services not rendered along with Drs. Sajadi and Sanjar. For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Nurses: Colorado Attorney General John Suthers announced on August 13 that Aracely Rodriguez pleaded guilty and was sentenced for one count of criminal possession of an identification document, a class 6 felony, and one count of Nurse Aide-Unauthorized Practice, a class 2 misdemeanor. The judge sentenced Rodriguez to two years of supervised probation, 48 hours of useful public service, $1,250 in fines, and no jail time. Rodriguez is to report her convictions to the Department of Regulatory agencies (DORA), and pay court cost fees. An investigation confirmed that Rodriguez used a false Social Security number and a false certified nurse aide license to obtain employment in a skilled nursing facility. For further information contact Assistant Attorney General Richard Ferro (303) or Criminal Investigator Eric Gutzait (303) Attorney General Suthers announced on August 31 that Vernita Jones pleaded guilty to and was sentenced for one count of felony forgery, and one count of theft, $500 or over but less than $1,000, a first degree misdemeanor. Jones was sentenced on a split plea. On the count of forgery, Jones received a deferred judgment with two years of supervised probation and court costs. On the count of theft, Jones received two years of supervised probation, 48 hours of useful public service, no fines, restitution in the amount of $5,225.90, and court costs. As an additional term of probation, she will report her convictions to the Department of Regulatory Agencies (DORA). Jones, a registered nurse, billed for services that she did not provide while she worked at a different facility.

15 For further information on both cases contact Assistant Attorney General Richard Ferro (303) or Civil and Criminal Investigator Terry Miles (303) Nurses: Ohio Attorney General DeWine announced on August 20 that Yolanda Ruffin pleaded guilty to one count of unauthorized use of property, a Misdemeanor of the first degree, and was sentenced to six months of jail time, and ordered to pay $1, in restitution. The jail time is to be suspended contingent upon payment of restitution by September 30, 2013, and provided no new convictions for two years. Ruffin, a registered nurse billed for services not rendered. For further information contact Assistant Attorney General Constance Nearhood (614) Nursing Homes: Texas Attorney General Abbott announced on August 23 that Peter Alan Kemp and Joanna Ellis Kemp were sentenced in federal court to five years of probation, and each was fined $10,000 and ordered to complete 100 hours of community service. The Kemps, owners of New Horizons General Partnership in Dallas, Texas, operated three ICF/MR residential homes in Hood County, Texas. They allegedly increased the costs reported as direct care wages and benefits on their annual cost reports by using ghost employees, and allegedly billed Medicaid for services that were not provided. The identified fraud is over $1.76 million. For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Ophthalmologists: Texas Attorney General Abbott announced on July 24 that Samuel Pierce, MD, pleaded guilty in federal court to an information charging him with health care fraud. Dr. Pierce paid $174, in restitution as part of a plea agreement. This case involves Medicaid and Medicare patients being seen for ophthalmology service at four satellite offices by opticians and billing for office visits by a physician. Over $174,000 in overpayments has been identified. For further information on both cases contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Patient Trust Funds: Texas Attorney General Abbott announced on July 27 that Melissa Carol Adler pleaded guilty in state court to securing execution of a document by deception. 15

16 Adler, while employed at Woodland Springs Nursing Center in Waco, Texas, allegedly orchestrated the execution of a resident's will by deception, resulting in Adler receiving more than $169,000 from the estate. Adler was allegedly assisted by attorney Raymond Eugene Rushing, the appointed federal fiduciary overseeing the victim's estate. Rushing entered into a pre-trial diversion agreement with special conditions on April 16, Attorney General Abbott announced on August 2 that laundry supervisor Shirley Ann Conley was indicted by a state grand jury for exploitation of an elderly individual. Conley allegedly asked an elderly resident of Senior Rehabilitation and Skilled Nursing Center of Port Arthur, Texas, to loan her money. Conley allegedly wrote checks on the residents personal checking account and signed the resident's name to the checks. Attorney General Abbott announced on August 2 that Alliance Home Healthcare Services coowner Edith Amadi was sentenced in federal court to 37 months imprisonment with two years of supervised release, and was ordered to pay $853, in restitution. She pled guilty in December 2011 to conspiracy to commit healthcare fraud. Amadi was indicted with co-owners Ernest Amadi. Agatha Opurum and George Opurum, and employee Ollie Futrell pleaded guilty for billing Medicaid and Medicare for unnecessary services. All have pled guilty to conspiracy to commit healthcare fraud. Futrell was sentenced to 33 months in prison. For further information on these cases contact Rick Copeland, Director or Chief Investigator Travis Tucker at (512) Physical Therapists: Texas Attorney General Abbott announced on August 6, that Nnonso Tony Obi pleaded guilty in federal court to conspiracy to commit health care fraud and to money laundering. Sentencing is pending. Obi was a marketer for City Nursing Services of Texas in Houston, Texas. City Nursing, owned and operated by Umawa Imo, billed Medicaid and Medicare for physical therapy services which were allegedly not needed and not provided. Obi and nine others were indicted for conspiracy, health care fraud, kickback violations, and money laundering for their roles. Four subjects have been sentenced to date, resulting in a combined prison time of 659 months and court ordered restitution of over $89 million. Between May 2007 to June 2009, Imo was paid more than $30 million by Medicaid and Medicare. For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512)

17 Physicians: Texas Attorney General Abbott announced on July 25, that Alicia Vasquez was sentenced in federal court to 12 months of incarceration, two years of probation, and was ordered to pay a $3,000 fine. Vasquez, a marketer, pled guilty to charges that she was paid by a physician for referring patients. The doctor allegedly took kickbacks for referrals to various DMEs and home health agencies. Attorney General Abbott announced on August 15, that Emmanuel Nwora, MD, and Charles Harris were indicted by a federal grand jury for conspiracy and health care fraud. Dr. Nwora allegedly billed for vestibular testing that was not needed or provided. Harris allegedly provided Dr. Nwora with the recipient information for the billing in return for a percentage of the reimbursement. The investigation is a joint effort with HHS-OIG, FBI, and the MFCU. Attorney General Abbott announced on August 29, that Rolando C. Vergel De Dios received one year of deferred adjudication community supervision, was ordered to perform 40 hours of community service, and pay a $500 fine after pleading guilty in state court to violating the medical practice act. Vergel De Dios allegedly impersonated a medical doctor for over a year and treated patients, admitted patients to a local hospital and wrote prescriptions for Schedule II and Schedule III narcotics while employed by Manuel Soriano Rivero, MD. Rivero died of natural causes in February For further information on these cases contact Rick Copeland, Director or Chief Investigator Travis Tucker (512) Podiatrists: Texas Attorney General Abbott announced on August 21 that Bhavesh J. Shah, DPM, and Andrea C. Iturrieta, a medical biller, were charged in an information with two counts of health care fraud. Dr. Shah, owner of South Texas Foot Institute in San Antonio, Texas, and Iturrieta allegedly submitted false claims for CPT codes and for more units of diabetic inserts than were furnished to patients. The fraud is more than $83,000. For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker (512)

18 Resident Abuse: South Dakota Attorney General Marty Jackley announced on August 29 that Marshall Dillon Lee Peterson was sentenced to 14 days in jail for assaulting a disabled child. In addition to the 14 days in jail, the judge suspended the imposition of sentence, and placed Peterson on probation for three years. Charges stemmed from an incident of simple assault that occurred while Peterson was employed at a healthcare facility in Sioux Falls. For further information contact Assistant Attorney General Paul Cremer at (605) Resident Abuse: Texas Attorney General Abbott announced on June 27, that Wilma Jean Columb was sentenced to eight years of probation, ordered to pay a $5000 fine, and write a letter of apology after pleading guilty in state court to injury to a disabled individual. Columb, while employed with Bacon Community Home in Abilene, Texas, allegedly abused a disabled resident by hitting him in the head with a radio cord. Attorney General Abbott announced on August 28, that Francis Uzoh pleaded guilty in state court to injury to a disabled individual. Uzoh, former assistant manager of Gentle Hands Home Care group home in San Antonio, Texas, was indicted in February 2010 for injury to a disabled individual. An employee of Gentle Hands witnessed Uzoh allegedly assaulting a client, resulting in a broken arm. This case is being prosecuted by the Bexar County District Attorney's Office. For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker at Social Workers: Texas Attorney General Abbott announced on August 6 that Andrew Staffier was given five years of deferred adjudication community supervision and was ordered to pay $15, in restitution. He pleaded no contest in June 2012 to Medicaid fraud. Staffier, a clinical licensed social worker and owner of Endeaver Health and Wellness, LLC, allegedly billed for case management services that were not provided to clients. For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker at (512)

19 CASE UPDATES Physicians Attorney General Abbott announced on July 17 that Cal Wade Graves pleaded guilty in federal court to conspiracy to commit healthcare fraud. Graves and Daniel Leong, MD, South Dallas Community Medical Center, were indicted in August 2011 for conspiracy to commit healthcare fraud. Dr. Leong allegedly billed for services not rendered and allowed physician s assistant Graves to prescribe controlled substances without a medical need. (See: Medicaid Fraud Report, July/August 2011, p. 18). The alleged Medicaid fraud identified is over $321,000. Attorney General Abbott announced on July 23 that Shayna Lee, MD, pleaded guilty in state court to engaging in organized criminal activity and was sentenced to ten years of deferred adjudication community supervision, ordered to perform 240 hours of community service and, to pay $70,000 in restitution. Lee, Eric Copeland, Mark Brown, Sherry James, Kevin Johnson, and Chaketa Williams were indicted in March 2011 for allegedly billing Medicaid and Medicare for psychological counseling and physical therapy services that were not provided. Brown and Copeland were sentenced to four years of incarceration after pleading guilty to theft. James received ten years of deferred adjudication community supervision and was ordered to pay $48,800 in restitution after pleading guilty to engaging in organized crime. Johnson was sentenced to four years of incarceration and was ordered to pay $25,000 in restitution after pleading guilty to theft. (See: Medicaid Fraud Report, March/April 2011, p. 24).The fraud is approximately $4.3 million. Attorney General Abbott announced on August 15, that Robert Baker pleaded guilty in federal court to conspiracy to violate anti-kickback statutes. Baker was a marketer allegedly paid to bring patients to Adom Rehabilitation and Physical Medicine in Houston, Texas. Tina Collins, MD, owner and operator of Adom, and employees Melloneen Davis and Cassandra Tasby, allegedly billed Medicaid for services that were not rendered and paid patients to attend her clinic and allow their Medicaid and Medicare identification numbers to be billed. (See: Medicaid Fraud Report, May/June 2011, p. 19). Dr. Collins pleaded guilty to conspiracy to commit health care fraud and was sentenced in May 2012 to 24 months of incarceration followed by two years of supervised release and was ordered to pay $1,894,938 in restitution to Medicare and $258,893 to Medicaid. Tasby and Davis pleaded guilty to conspiracy to commit health care fraud. 19

20 They were each sentenced in May 2012 to 36 months of probation with four months of home confinement and were ordered to jointly and severally pay $42, in restitution to Medicare and $8, to Medicaid. The identified overpayment is over $1.3 million. State Employees: Texas Attorney General Abbott announced on July 25 that Veronica Zamora was sentenced in federal court to four years of probation and was ordered to pay $53,878 in restitution. Zamora pled guilty in February 2012 to theft of funds from a health care benefit program. (See: Medicaid Fraud Report, July/August 2012, p. 17). Angela Grado was sentenced on July 12, 2012, to five years of probation and ordered to pay $ 30, in restitution for her role in defrauding the medical transportation program. Olivia Cardenas, Michael Zamora, Ericka Rojas, and Priscilla Rojas were sentenced on July 10, 2012, for their roles in the scheme. Cardenas, a former state employee, was sentenced to 15 months of imprisonment and was ordered to pay $53,878 in restitution. Zamora was sentenced to 10 months in prison, three years of supervised release, and was ordered to pay $53,878 in restitution. Ericka Rojas and Priscilla Rojas were each sentenced to three years of probation and were ordered to pay $53,878 each in restitution.. Veronica Zamora, along with seven former state employees and 11 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 in San Antonio 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. For further information contact Director Rick Copeland or Chief Investigator Travis Tucker (512)