MEDICAID FRAUD REPORT

Transcription

1 MEDICAID FRAUD REPORT National Association of Medicaid Fraud Control Units July/August 2014 INSIDE Texas Mental Health Owner and Recruiters Plead Guilty... 1 Cases... 2 Case Updates Texas Mental Health Owner and Recruiters Plead Guilty Attorney General Greg Abbott announced on August 6 that William Clarence Bullock III pleaded guilty in federal court to conspiracy to commit healthcare fraud. Bullock owned and operated Dynamic/Caroline PHP, a mental health center, which allegedly submitted billing for psychiatric counseling services which were either not provided or not medically necessary. Billing was submitted through Riverside General Hospital. In addition to its main location, Riverside General Hospital operated approximately ten Community Mental Health Centers (CMHC) which each administered a Partial Hospitalization Program (PHP) and each submitted billing under the hospital s billing number. Riverside General Hospital allegedly paid marketer/recruiters to help provide patients whose Medicaid and Medicare accounts could be billed for treatment and allegedly paid physicians to falsify patient eligibility and treatment records. Patients at the CMHCs were primarily residents of group homes and were transported by van or ambulance to the facilities. Most allegedly did not meet the eligibility criteria for PHP services. On July 28, Sharonda Denise Holmes pleaded guilty in federal court to conspiracy to commit health care fraud. Holmes allegedly was a recruiter who received kickbacks to provide clients for outpatient psychiatric services at Riverside General Hospital. On August 21, Waddie Jermar McDuffie pleaded guilty in federal court to conspiracy to pay and receive healthcare kickbacks. McDuffie was one of the marketers/recruiters who allegedly received kickbacks to provide clients for outpatient psychiatric services at Riverside General Hospital. For further information contact Rick Copeland, Director or Chief Investigator Travis

2 CASES Adult Homes: Oregon Attorney General Ellen Rosenblum announced on August 27 that Constance Marie Herrera-Firkus, an operator of two adult foster homes and who was paid with Medicaid funds to care for elder persons, was sentenced to 12 months and one day in prison and five years of probation. She was ordered to pay $6, in restitution and $30,000 in compensation fee after she pleaded guilty to six felonies, including three counts of identity theft, making a false claim for health care payment, aggravated theft, and tax evasion. She must have no contact with her granddaughter whose identity she stole or any prior resident of the adult foster homes, may not be employed in health care or in-home care, whether by public or private pay, or as a bookkeeper or similar position, and must complete evaluation for counseling. Lorisa Firkus-Gardner, an employee, provided a false name to the licensing board to avoid detection as a convicted felon, which Herrera-Firkus aided in this identity theft. Further investigation revealed that Firkus-Gardner was convicted of and on probation for theft in the first degree for a prior theft from her former employer, and which disqualified her from employment at any Medicaid-funded adult foster home. With the assistance of co-defendant, Constance Marie Herrera-Firkus, her grandmother who operated two adult foster homes, Firkus -Gardner stole the identity of her cousin and used this identity to continue working there, and to avoid reporting income. During the three to four years that Firkus-Gardner worked for Herrera- Firkus, both submitted the false names on numerous occasions so that Herrera-Firkus would be paid additional public funds, and to avoid detection for tax liability. For further information contact Senior Assistant Attorney General Melissa M. Chureau (971) Dentists: Texas Attorney General Abbott announced on July 10 that Alonzo Yepez was sentenced to ten years of deferred adjudication community supervision, ordered to perform 200 hours of community service and to pay $8,862 in restitution after he pleaded guilty in state court to theft. Yepez, a former dental office manager, allegedly billed Medicaid for dental services not rendered under his deceased sister s dental license and Medicaid provider number. For further information contact Rick Copeland, Director or Chief Investigator Travis Drug Diversion: Texas Attorney General Abbott announced on June 9 that certified nurse s aide (CNA) Linda J. Salgado was indicted for possession of a dangerous drug. CNA Salgado allegedly stole tramadol from the discontinued portion of the medication cart at Parkview Nursing and Rehabilitation. 2

3 Attorney General Abbott announced on July 8 that certified medication aide (CMA) Tracy Hernandez was sentenced to six years of community supervision, ordered to perform 160 hours of community service and to pay $2,500 in fines after she pleaded guilty in state court to possessing controlled substances by fraud. CMA Hernandez allegedly stole hydrocodone from a resident of Apex Secure Care for her own use. Attorney General Abbott announced on August 11 that Gabrielle Denean Sims, a licensed vocational nurse, entered into a two year pre-trial diversion agreement and was ordered to pay a $500 fine. Sims was indicted by a state grand jury for possession of a controlled substance by fraud for allegedly stealing hydrocodone from residents of Robert Lee Care Center. Attorney General Abbott announced on August 14 that licensed vocational nurse (LVN) Tracie Elaine West was sentenced to five years of deferred adjudication community supervision and was ordered to pay $1,500 in fines after she pleaded guilty in state court to diversion of a controlled substance and tampering with evidence. While employed at Winnie L. Nursing and Rehabilitation, she allegedly stole a resident s methadone for her own use. For further information on these cases contact Rick Copeland, Director or Chief Investigator Travis Durable Medical Equipment: Texas Attorney General Abbott announced on July 16 that Christine Rodriguez and Luis Alberto Sanchez Martinez were sentenced in state court. Rodriguez, office manager for Valley Medical Depot, was sentenced to two years of deferred adjudication community supervision after she pleaded guilty to Medicaid fraud. On July 11, Jackson Durable Medical Equipment, LLC, was ordered to pay $161,898 in restitution for allegedly billing for incontinence supplies that were not delivered. Martinez, a delivery driver, was indicted for theft for allegedly billing for incontinence supplies that were not delivered. Martinez pleaded guilty and was sentenced to two years of probation. He was ordered to pay $5,000 in restitution. The fraud is approximately $199,000. For further information contact Rick Copeland, Director or Chief Investigator Travis Home Health Care Agencies: Ohio Attorney General Mike DeWine announced on August 7 that Eric Isakov, owner of Janis Home Health Care, was sentenced to 42 months in prison, two years of supervised release, 3

4 and was ordered to pay $900,000 in restitution and a $100 fine. Janis Home Health Care operated under a system of kickbacks to get and keep patients that were receiving physical therapy. On December 30, 2013, a bill of information was filed charging Isakov with one count healthcare fraud. On February 6, Isakov pleaded guilty to one count healthcare fraud. Attorney General DeWine announced on August 13 that Kendra M. Mitchell was sentenced to 30 days in jail and was placed on community control for 12 months (nonreporting) or until restitution was paid in full, and ordered to pay $ in restitution after she pleaded guilty to theft. Michelle worked for Omnicare Home Health Agency and claimed services were rendered to a Medicaid recipient during periods when she was hospitalized. An indictment was filed on March 18 charging Mitchell with one count of forgery and one count theft. Attorney General DeWine announced on August 27 that Audrey Stubbs was sentenced to a 12 month term of community control and ten day jail credit after she pleaded guilty to Medicaid fraud. On June 24, 2013 an indictment was filed charging Stubbs with three counts of aggravated theft by deception, three counts of falsification in a theft offense, three counts of Medicaid fraud, three counts of telecommunications fraud, three counts of tampering with evidence; three counts of engaging in a pattern of corrupt activity, one count of money laundering, five counts of workers compensation fraud, two counts of workers compensation fraud; two counts workers compensation fraud, and 85 counts of forgery. Stubbs was the office manager and Medicare biller at Palladium Health Care LLC, a home health agency. Palladium billed for many services not rendered or not authorized. While knowing the agency was on hold and review and in anticipation of an upcoming audit, Palladium employees were directed by Porter and/or Stubbs to create fictitious nursing notes, supervisory visit records, and 485s, in order to substantiate fraudulent billings that had previously been submitted. As a result, Palladium billed over $360,000 in services not rendered and/or authorized. Four former employees, three nurses and the office biller, have been convicted for their involvement in this scheme to defraud For further information on both cases contact Keesha R. Mitchell, Director (614) 466- Home Health Care Aides: Ohio Attorney General DeWine announced on April 28 that Latasha Polston was sentenced to 18 months in prison and ordered to pay $35,000 in restitution after she pleaded guilty to theft. Polston was a home health aide who over a three year period of time billed for services not 4

5 rendered to four different recipients For further information contact Assistant Attorney General Nathan Smith (614) 466- Attorney General DeWine announced on July 2 that Ege H. Abshir, a Medicaid recipient eligible to receive home health services, was sentenced to five years of probation, serve six months at the corrections center, be suspended and placed on non-reporting probation and was ordered to pay $3,500 in restitution after he pleaded guilty to theft. Abshir reported that his home health agency was billing for services not rendered, and admitted his own involvement in a kickback scheme. His home health agency billed for home health services over a time period when his home health aide was out of the country. Attorney General DeWine announced on July 14 that registered nurse (RN) Ashley N. Stafford was sentenced to serve 14 days at the correction center and ordered to pay $200 in fines and court costs for attempted forgery. Stafford signed off on fraudulent 485s without ever conducting a medical examination of the Medicaid recipient and admitted to never assessing or examining the recipient. Stafford explained that Sheryl Gibbs, LPN, would meet her in a parking lot at McDonald s and ask her to sign off on the forms as a favor to Gibbs. The lack of oversight allowed Heather Roberts, mother of Gibbs and the recipient, to engage in a kickback scheme. Gibbs would allegedly bill 56 hours a week of nursing services but provide around hours per week. In exchange, Gibbs paid Roberts $300 - $400 a week. Attorney General DeWine announced on July 18 that Dawn R. Hollie-Gillard, an independent provider, was sentenced to five years of probation, ordered to serve 12 months at a corrections center and to pay $37,000 in restitution for falsification in a theft offense. Hollie- Gillard billed for services not rendered to Medicaid recipients and forged signatures for one of the recipients over the course of three years. Attorney General DeWine announced on July 18 that Molly E. Rabe and her sister, Patricia Powell, home health aides pleaded guilty to theft. Rabe was ordered to pay $10,000 in restitution. Powell was sentenced to six months of probation, ordered to serve 30 days in a corrections center and to pay $20,000 in restitution. Rabe and Powell worked to bill Medicaid for services that were not rendered to Powell s son. They created false timesheets and submitted fraudulent claims of service. Rabe 5

6 was employed as a home health aide and a housekeeper with Terrace View Gardens. Her timesheets reflected an overlap of services between her services as a home health care aide and her employment at Terrace View Gardens. Attorney General DeWine announced on July 21 that Christopher Edmondson was sentenced to five years of probation, ordered to serve six months at the corrections center and to pay $85, in restitution for theft. Edmondson was an independent provider for developmentally disabled Medicaid recipients. The referral showed that Edmondson had multiple overlapping hours between recipients. Attorney General DeWine announced on July 31 that Theresa Thurman, an independent provider, working for the Better World Health Care, was sentenced to three years of probation and ordered to serve 90 days at a corrections center for obstruction of official business. She was also ordered to pay $2, in restitution for falsification in a theft offense. Thurman was reported by her Medicaid consumer, who has MS, in a news report that Thurman left her alone for an entire weekend forcing the consumer to depend on others for care. Thurman billed for $2, in services not rendered. Attorney General DeWine announced on August 26 that Heather Prock was sentenced to three months in a corrections center, suspended provided no new offenses for a period of one year, and ordered to pay $396 in restitution in full on or before February 28, 2015 after she pleaded guilty to Medicaid fraud. On January 21, an indictment was filed charging Prock with forgery, Medicaid fraud and attempted Medicaid fraud. She served as a home health aide and billed for services not rendered to a Medicaid recipient. The recipient disputed timesheets submitted and indicated that Prock was not authorized to use her signature stamp on various timesheets For further information on these cases contact Keesha R. Mitchell, Director (614) 466 Home Health Care Aides: Oregon Attorney General Rosenblum announced on May 27 that Gabriella Aguayo, a Medicaidpaid home care worker, was sentenced to 18 months of supervised probation, ordered to complete 160 hours of community service, have no contact with the recipient, or engage in home care, whether paid by public funds or private pay and ordered to pay $ in restitution after she pleaded guilty to a felony count of identity theft. Aguayo forged the recipient s signature on at least one voucher for which she was paid over $600 for work that she did not do. 6

7 For further information contact Senior Assistant Attorney General Melissa M. Chureau (971) Attorney General Rosenblum announced on August 28 that Danny Lee Harbick was convicted and sentenced to ten days in jail and 18 months of probation after he pleaded guilty to two counts of identity theft. He was charged with various counts of identity theft, forgery and attempted theft. Harbick was employed as a Medicaid paid home care worker for a Medicaid recipient. When the recipient was hospitalized and died, Harbick continued to submit two vouchers for payment, and signed the recipient s name to the vouchers. Additionally, he was ordered not to work as a Medicaid or Medicare provider. For further information contact Senior Assistant Attorney General Elizabeth Ballard (971) Home Health Care Aides: South Carolina Attorney General Alan Wilson announced on August 4 that Staci Q. Norris, an early interventionist employed with Bright Star, a home care and medical staffing agency, was sentenced to six months in prison, order suspended upon six months of probation, along with full costs of restitution after she pleaded guilty to one count of Medicaid provider fraud. From April 2010 to November 2012, Norris failed to render services to a child at the daycare. When confronted Norris stated that she could not find the missing paperwork where she provided services to the child. Norris's supervisor followed up with the daycare teacher to see if the services were being provided to the child. The teacher at the daycare said she thought services were being provided in the child's home since she had not been to see the child for months at the daycare. The paperwork that Norris submitted to Bright Start indicated that services were being provided. Norris's supervisor reviewed her billing and found 25 instances without supporting documentation over the last several years. For further information contact Assistant Deputy Attorney General Michael Burchstead or Investigator Kevin Caldwell (803) Home Health Care Aides: Texas Attorney General Abbott announced on August 21 that Coninja Lolitta Byrd was indicted by a state grand jury for aggravated theft. Byrd, mother of a juvenile Medicaid recipient, allegedly conspired with others and submitted fraudulent time sheets to Harris County Home Health Services for personal care services provided to Byrd s juvenile daughter. During the time of the submissions, the named service provider was incarcerated. For further information on contact Rick Copeland, Director or Chief Investigator Travis 7

8 Home Health Care Aides: Washington Attorney General Bob Ferguson announced on July 24 that John Aaron Robinson was sentenced as a first-time offender to 240 hours of community service, six months of community custody, and was ordered to pay $7,500 in restitution and fees after he pleaded guilty to one count of first degree theft and one count of Medicaid false statement. Robin Gray was convicted of six felonies and was sentenced to 17 months in prison. Robinson contracted to provide in-home care to a Medicaid client through the Health Care Authority, Community Options Program Entry System. From August 2012 to August 2013, Robinson billed and was paid by Medicaid in Washington for care he claimed to have performed while he was in fact holding down an unrelated job. He allowed his domestic partner, Gray, to provide care in his place. Of particular concern to investigators was the fact that Gray had previously been convicted of felony theft for exploiting a vulnerable adult and had therefore been disqualified from serving as an individual provider. Attorney General Ferguson announced on August 8, that Han Bae Kim was sentenced to six months of community custody, 240 hours of community service, executed a voluntary exclusion agreement with OIG and ordered to pay $15,057 in restitution to the government victims as a first time offender to one count of first degree theft and three counts of second degree theft. The felony theft involved three types of theft - from Medicaid, Social Security, and the EBT card program. Kim contracted to provide in-home personal care services for his mother, a Medicaid client. Over several years from March 2011 to January 2013 Kim claimed to be providing healthcare services to a Medicaid client, who had since left the country and died. Kim commandeered the client s personal government benefits during this time. For further information on both cases contact Assistant Attorney General Mike Pellicciotti (360) Identity Theft: Vermont Attorney General William Sorrell announced on August 5 that Crystal Hathaway- Therrien was sentenced to two and a half to five years in jail, all suspended, placed on two years of probation subject to certain conditions, including 100 hours of community service and ordered to pay $7,150 in restitution for five misdemeanor counts of false pretenses. Hathaway-Therrien submitted of false timesheets in order to obtain payment for services that were not provided to a child enrolled in the Children s Personal Care program, a Vermont Medicaid program. Hathaway-Therrien signed and submitted the timesheets in her capacity as the employer-of-record and received the proceeds For further information contact Assistant Attorney General Micaela Tucker (802) 828-8

9 Medical Transportation: Massachusetts Attorney General Martha Coakley announced on August 21 that Cynthia J. Keegan was sentenced to a year and a half in jail and ordered to pay in full restitution for defrauding the state s Medicaid program (MassHealth) of more than $470,000 by billing for services under the names of deceased individuals, and for other medical trips which were never provided. Keegan pleaded guilty to seven counts of larceny over $250 and seven counts of Medicaid False Claims and was sentenced to two and half years in jail, with 18 months to serve, and the balance of that sentence suspended for eight years. Keegan was also sentenced to eight years of probation and ordered to pay $477,658 dollars in restitution to MassHealth. In addition, her company Keegan Enterprises, LLC, d/b/a Cross Roads Trolley was fined a total of $245,000. Cross Roads Trolley is a privately held wheelchair van company that provides non-emergency medical transportation services when personal transportation is not suitable due to the MassHealth member s physical condition. Keegan falsely billed for rides provided to more than 40 individuals after their death, and under the names of a dozen residents at two different nursing homes who never actually received rides on the claimed dates of service. Over a five year period, she submitted more than 8,300 fraudulent transportation claims for 12 residents at two nursing facilities, and received payments totaling more than $400,000. Nurses: Ohio For further information contact George Zachos, Director (617) Attorney General DeWine announced on March 10 that April McCarty, a nurse, was sentenced to 18 months suspended, placed on five years community control and ordered to pay $45,000 in restitution. An indictment was filed on August 20, 2013 charging McCarty with Medicaid fraud, falsification in a theft offense and tampering with evidence. She continued to bill Medicaid even though she moved out of Ohio. Nurses: Texas For further information contact Keesha R. Mitchell, Director (614) Attorney General Abbott announced on August 13 that Jada Necole Antoine was indicted by a federal grand jury for aggravated identify theft. Antoine allegedly stole the identity of a registered nurse and used it to obtain employment at Heart to Heart Hospice of Texas and Odyssey Healthcare. Using the stolen identity, Antoine, an unlicensed medical professional, allegedly visited Medicare and Medicaid patients receiving hospice care. These services were billed to Medicare and Medicaid by Heart to Heart and Odyssey which were unaware that Antoine was using a stolen identity. 9

10 Attorney General Abbott announced on August 21 that registered nurse Rhonda Louk Kuehn was indicted by a state grand jury for aggravated theft. While employed by EPIC Medstaff Home Health and Hands of Grace, RN Kuehn allegedly conspired with two foster home owners to falsify private duty nursing claims to both EPIC Medstaff and Hands of Grace. RN Kuehn allegedly falsified multiple time sheets that the foster home owners confirmed as accurate. For further information on both cases, contact Rick Copeland, Director or Chief Investigator Travis Personal Care Aides: Oregon Attorney General Rosenblum announced on July 8 that Marcus Morton, a personal support worker, was sentenced to five years of supervised probation and was ordered to pay $48,000 in restitution for three felony counts of making a false claim for health care payment after he pleaded guilty on April 8. He also was sentenced to serve 180 days in home detention, perform 300 hours of community service and complete moral reconation therapy. During his probation, he must not have contact with any of his prior clients or brokerages, or any DD persons, and must not be employed in any care giving for the developmentally disabled. For further information contact Senior Assistant Attorney General Melissa M. Chureau (971) Personal Care Services: Idaho Attorney General Lawrence Wasden announced on July 24 that Robin Villarreal- Ratcliff was sentenced to probation for four years and ordered to pay $2,889 in combined restitution and additional court fines and costs for using a computer to submit fraudulent claims for Medicaid services On June 2, Villarreal-Ratcliff was found guilty after entering an "Alford plea," thereby admitting that the State has sufficient evidence that a jury would likely find her guilty. The plea covers one felony count of a Computer Crime. Villarreal-Ratcliff operated a family alternative care home that provided personal care services (PCS). During the time period of February 2011 to March 2012, Villarreal-Ratcliff billed Medicaid for providing personal care services to two Medicaid recipients who were children when those services were not actually provided by her, because she was vacationing in Costa Rica, Seattle, Washington, Pensacola, Florida and Lihue, Hawaii For further information contact Deputy Attorney General Laura A. Perkovic (907)

11 Physicians: Texas Attorney General Abbott announced on July 24 that Tariq Mahmood, MD, was found guilty of conspiracy to commit health care fraud, health care fraud, and aggravated identity theft in federal court. Dr. Mahmood, owner of Cozby-Germany Hospital, allegedly instructed his medical coders to change the medical coding in order to receive a higher reimbursement from Medicare and Medicaid. For further information contact Rick Copeland, Director or Chief Investigator Travis Resident Abuse: Ohio Attorney General DeWine announced on August 6 that Nichole Crome, a state tested nursing assistant at Crown Pointe Care, was sentenced to zero days, costs were waived and ordered to pay a fine of $75 after she pleaded guilty to disorderly conduct, a felony of the fourth degree. On December 30, 2013 an indictment was filed charging Crome with one count of patient abuse witnessed by an aide-in-training. For further information contact Keesha R. Mitchell, Director (614) Resident Abuse: South Carolina Attorney General Wilson announced on July 17 that CNA Becky Ann Alwai was sentenced to two years in prison, suspended upon service of 12 months of probation after she pleaded guilty to one count of assault and battery in the second degree. On July 26, 2012, CNA Alawi transferred nursing home resident with a Hoyer lift/sling without the assistance of a second person. During the transfer, the resident s foot became caught beneath her and the chair. CNA Alawi was aware that the Hoyer lift required two people to move a resident. She had received staff training on the lifts on July 22, 2012 and an instructed demo of physical transfers of the Hoyer lift on July 23, CNA Alawi stated that she simply forgot about the training and the new policy requiring two person lifts for transfers in all situations involving moving of a resident. For further information contact Senior Assistant Deputy Attorney General C. William Gambrell, Jr. or Investigator Ryanne Gillum (803) Resident Abuse: Texas Attorney General Abbott announced on August 5 that personal services assistant, Hilary Marie Townsend was sentenced to one day in jail, time served, after being found guilty in state court of assault. While employed at the Winkler House, Townsend allegedly slapped a resident across the face, and pushed her down on her bed which resulted in an injury to the resident. 11

12 For further information contact Rick Copeland, Director or Chief Investigator Travis Resident Neglect: Ohio Attorney General DeWine announced on July 16 that Judy A. Conyers, a nurses aid at Twin Towers, was ordered to pay $110 in fees for gross patient neglect through poor quality of care which resulted in a fractured femur when transferring a resident. For further information contact Keesha R. Mitchell, Director (614) Resident Trust Funds: Ohio Attorney General DeWine announced on July 17 that Regina M. Buhalak, a housekeeper at Pebble Creek, was sentenced to two years of probation and six months of suspension for theft from the elderly. A resident reported her missing ipad and it was determined that Buhalak had used another residents debit card to withdraw $262 which was unauthorized. Attorney General DeWine announced on August 11 that Ashley D. Jenkinson, an nurse aide working for the Brethren Retirement Community, was sentenced to two years of probation, ordered to 75 hours of community service and to pay $275 in court costs and $ in restitution for falsification in a theft offense. Jenkinson stole a resident s credit card and purchased a swing set at Wal-mart. Attorney General DeWine announced on August 13 that Misty O Leary pleaded guilty to theft in the first degree. She was ordered to pay $75 in restitution, received a suspended sentence of 180 days in jail and was placed on community control for two years (basic supervision). O Leary abused her authority as an employee of a nursing home facility and kept money entrusted to her by a resident for deposit. It was company policy to turn all funds collected from residents into the office so it could be placed into their personal account, and in return the nursing home would provide a receipt to the resident for documentation. Although O Leary initially denied the allegation, she eventually admitted to stealing money in order to purchase medication. On May 21, Misty O Leary was indicted for theft from an elderly person or disabled adult. 12

13 Attorney General DeWine announced on August 21 that India Johnston was sentenced to 20 days in jail, suspended and placed on six months of probation, and ordered to pay $ in restitution for theft. On October 25, 2013, an indictment was filed charging Johnston with theft. Johnston had stolen a credit card from a resident at the Village of Westerville and had used it to purchase gas and food. For further information on these cases contact Keesha R. Mitchell, Director (614) Resident Trust Funds: Texas Attorney General Abbott announced on July 2 that Jennelle Lynn Gonzalez was sentenced to two years of deferred adjudication community supervision and ordered to pay $600 in restitution after she pleaded guilty in state court to forgery and exploitation of a disabled individual. Gonzalez, while employed at Coastal Plains Community as a human service technician, allegedly forged personal checks from a resident for her own benefit. Attorney General Abbott announced on July 24 that David Tony Duran, a business office manager of Slaton Care Center, was sentenced to five years of community supervision, ordered to perform 300 hours of community service and to pay $12, in restitution after he pleaded guilty in state court to misappropriation fiduciary/finance property of the elderly. Duran allegedly stole $2,300 from the residents trust fund accounts. For further information contact Rick Copeland, Director or Chief Investigator Travis CASE UPDATES Durable Medical Equipment: Texas Attorney General Abbott announced on August 22 that Lawrence Tyler was sentenced in federal court to 72 months in prison with three years of supervised release, forfeit his home and was ordered to pay $147,000 in restitution to Medicaid and $1.2 million to Medicare. Tyler was convicted at trial of conspiracy to commit healthcare fraud, healthcare fraud, and money laundering. Tyler, owner/operator of Houston-based IC PAYDAY.com, LLC, allegedly billed for arthritis kits and other durable medical equipment which was not delivered. The identified overpayment is $1.1 million. (See Medicaid Fraud Report, May/June 2014, p. 3). Attorney General Abbott announced on August 26 that Andrea Michelle Tellison was sentenced in federal court to 96 months in prison with three years of supervised release, and 13

14 ordered to pay $274,000 in restitution to Medicaid, $935,000 to Medicare, and $7,700 to United Healthcare. She was found guilty at trial in April of healthcare fraud and aggravated identity theft. Tellison, owner/operator of Texas Durable Medical Equipment, allegedly billed Medicaid and Medicare for enteral feeding supplies, wheelchairs, and incontinence supplies which were not provided. The identified overpayment is $103,000. (See Medicaid Fraud Report, May/June 2014, p. 3). Attorney General Abbott announced on August 28 that James Claude Newman was sentenced in federal court to 36 months in prison with one year probation, and was ordered to pay $1,361, in restitution after he pleaded guilty in April to false statements related to healthcare matters. Newman, a contractor for Hall s Pharmacy and Aledo Medicine, allegedly made false statements related to Medicaid/Medicare claims for diabetic shoes and inserts. (See Medicaid Fraud Report, March/April 2014, p. 5). For further information on these cases contact Rick Copeland, Director or Chief Investigator Travis Medical Transportation: Texas Attorney General Abbott announced on August 21 that William Morris Harvill was sentenced in federal court to 12 months and one day in jail followed by three years of supervised release and was ordered to pay $787, in restitution after Harvill pleaded guilty to conspiracy to commit healthcare fraud. On August 4, Cathy Dianne Harvill was sentenced to 27 months in jail followed by three years of supervised release and ordered to pay $787, in restitution in federal court. The Harvills pleaded guilty in February to conspiracy to commit healthcare fraud. (See Medicaid Fraud Report, January/February 2014, p.13). On August 4, Shon Everett Cooper was sentenced was sentenced to five years of supervised release with intermittent confinement on weekends for the first year and ordered to pay $93, in restitution with joint liability with Cathy and William Harvill in federal court after he pleaded guilty in January to theft of government property. The Harvill s owned North East Texas EMS, and allegedly billed Medicare and Medicaid for transports when the patients did not meet the Medicare and Medicaid qualifications for the transports. Cooper was a manager for North East Texas EMS. The Medicaid overpayment is approximately $96,500, and the Medicare overpayment is approximately $689,700. For further information contact Rick Copeland, Director or Chief Investigator Travis 14

15 Pharmacists: Texas Attorney General Abbott announced on July 14 that Lisa Lyn Hollier, owner and operater of Urban Independent Pharmacy, was sentenced in federal court to 60 months of incarceration with two years of supervised release. She was found guilty in February of conspiracy to distribute a controlled substance. (See: Medicaid Fraud Report, January/February 2014, p.14). She was convicted at trial with four co-defendants for their roles in a pill mill operation involving 14 recruiters and Nicolas Alfonso Padron, MD, and his office manager at Padron Wellness Clinic. Nine of the 17 defendants have pleaded and been sentenced. For further information contact Rick Copeland, Director or Chief Investigator Travis Wellness Centers: Texas Attorney General Abbott announced on August 29 that physician s recruiter Stephanie Elaine Stokely was sentenced in federal court to two years of probation. Stokely is one of 14 recruiters previously indicted for recruiting patients for visits to Padron Wellness Clinic. Nicolas Padron, MD, his office manager and the recruiters allegedly conspired to distribute controlled substances via prescription without a legitimate medical purpose through Padron Wellness Clinic and pharmacist Lisa Hollier of Urban Independent Pharmacy. Ten of the 17 subjects, including Stokely, have pleaded or have been found guilty and sentenced. Seven subjects are scheduled for sentencing in September and October. (See Medicaid Fraud Report, March/April 2014, p.19). For further information contact Rick Copeland, Director or Chief Investigator Travis 15

16 Inquires on editorial content should be addressed to: Barbara L. Zelner Executive Director National Association of Medicaid Fraud Control Units 2030 M Street NW, 8th Floor Washington, DC [email protected] Jim Hood Rodney Hopkinson James McPherson President President Executive Director National Association National Association National Association of of of Attorneys General Medicaid Fraud Control Units Attorneys General The views and opinions of authors expressed in this newsletter do not necessarily state or reflect those of the National Association of Attorneys General (NAAG). This newsletter does not provide any legal advice and is not a substitute for the procurement of such services from a legal professional. NAAG does not endorse or recommend any commercial products, processes, or services. Any use and/or copies of the publication in whole or part must include the customary bibliographic citation. NAAG retains copyright and all other intellectual property rights in the material presented in the publications. Copyright 2014, National Association of Attorneys General 16

17 INDEX OF CASES ADULT HOMES... 2 DENTISTS... 2 DRUG DIVERSION Tracy Hernandez... 3 Linda J. Salgado... 2 Gabrielle Denean Sims... 3 Tracie Elaine West... 3 DURABLE MEDICAL EQUIPMENT Luis Alberto Sanchez Martinez and Christine Rodriguez... 3 James Claude Newman Andrea Michelle Tellison Lawrence Tyler HOME HEALTH CARE AGENCIES Eric Isakov... 3 Kendra M. Mitchell... 4 Audrey Stubbs... 4 HOME HEALTH CARE AIDES Ege H. Abshir... 5 Gabriella Aguayo... 6 Coninja Lolitta Byrd... 7 Christopher Edmondson... 6 Han Bae Kim... 8 Danny Lee Harbick... 7 Dawn R. Hollie-Gillard... 5 Staci Q. Norris... 7 Latasha Polston... 4 Patricia Powell and Molly E. Rabe... 5 Heather Prock... 6 John Aaron Robinson... 8 Ashley N. Stafford... 5 Theresa Thurman... 6 IDENTITY THEFT... 8 MEDICAL TRANSPORTATION Shon Everett Cooper, Cathy Dianne Harvill, and William Morris Harvill Cynthia J. Keegan... 9 NURSES Jada Necole Antoine

18 INDEX OF CASES Rhonda Louk Kuehn April McCarty... 9 PERSONAL CARE AIDES PERSONAL CARE SERVICES PHARMACISTS PHYSICIANS RESIDENT ABUSE Becky Ann Alwai Nichole Crome Hilary Marie Townsend RESIDENT NEGLECT RESIDENT TRUST FUNDS Regina M. Buhalak David Tony Duran Jennelle Lynn Gonzalez Ashley D. Jenkinson India Johnston Misty O Leary WELLNESS CENTERS