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National Association of Medicaid Fraud Control Units

MEDICAID FRAUD REPORT

July/August 2008 INSIDE Minnesota MFCU Convicts Co-Owners Of Nursing Agency......................1 Cases.............................................2 Case Updates ...............................22 Minnesota MFCU Convicts Co-Owners of Nursing Agency Attorney General Lori Swanson announced on June 30 that Gloria and Ransford Savage, co-owners of Wild Flower Health Care Services, Inc. (Wild Flower) were convicted of one felony level count of theft by swindle and one gross misdemeanor count of criminal neglect, respectively. Wild Flower was enrolled in the Medicaid program as a private duty nursing (PDN) agency but also provided personal care assistant (PCA) services. Gloria was a licensed practical nurse (LPN) and Ransford was a personal care assistant. The allegations were that the agency was billing the Department of Human Services (DHS) for registered nurse (RN) services when there was no RN on staff, billing DHS for RN services when the services were being provided by a licensed practical nurse (LPN), billing for unqualified workers, and billing for services not provided and/or without the required documentation. The Minnesota Medicaid Fraud Control Unit executed a search warrant on Wild Flower. Documents recovered during the search revealed that Wild Flower was billing for RN services rendered by LPNs. From August 2005 through March 2007, DHS paid Wild Flower $221,367 for RN services that were not provided by an RN. The MFCU was able to verify that Wild Flower employed one RN who typically worked three to four hours per week. However, each month, Wild Flower submitted claims to DHS on behalf of three recipients for RN services for hundreds of hours of RN services. For example, in the month of January 2007, Wild Flower billed 744 hours of RN services for one client.

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Wild Flower had four employees for whom no background checks were requested. Background checks are required by law when individuals are providing direct contact services to vulnerable adults. DHS paid Wild Flower $1,483.04 for services provided by employees without background checks. The MFCU investigation determined that some of Wild Flower's clients were authorized to receive one-to-one PCA services, but the clients were not receiving one-to-one PCA services-the clients were receiving "shared care." In other words, Wild Flower was providing one PCA to provide services to two clients. Documents obtained in the search also revealed that Wild Flower PCAs were allowed to sleep for 8 hours when working a 24 hour shift. Medicaid does not reimburse time spent sleeping. In addition, Wild Flower failed to properly supervise its clients, did not provide its clients with the recommended servings of fruit, vegetables, and milk, and did not keep medication in a locked, secure location. Imposition of Gloria's sentence was stayed and she was placed on probation for a period of ten years with the conditions that she perform 180 days in the Sentence to Service program within 365 days, pay a fine in the amount of $100, and pay Medicaid restitution to the Department of Human Services in the amount of $75,000, joint and several with Ransford. This matter was referred to the Minnesota Board of Nursing for its consideration of licensing action based upon this conviction. Imposition of Ransford's sentence was stayed and he was placed on supervised probation for a period of two years with the conditions that he perform 180 days in the Sentence to Service program within 365 days, pay a fine in the amount of $100, and pay Medicaid restitution to the Department of Human Services in the amount of $75,000, joint and several with Gloria. In addition, Gloria and Ransford must provide a DNA sample and they may not accept employment requiring reimbursement from Medicaid. For further information on both cases contact Assistant Attorney General Gina Jensen (651) 297-1093. CASES Adult Family Homes: Washington State Attorney General Rob McKenna announced on June 30 that Bonnie L. Olsen pleaded guilty to one count of Theft in the First Degree and five counts of Medicaid False Statement and was sentenced to serve 30 days of in home monitoring and 12 months of community supervision. She was ordered to make restitution in the amount of $5,890 to the Medicaid program and to pay court costs, fines and victim assessment fees of $1,300. Investigator Amy Rose conducted the investigation for the Washington State MFCU and Assistant Attorney General Lynn Mounsey prosecuted the case. She found that Olsen was a 2

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licensed nursing assistant and owner of the Precious Times Adult Family Home. Olsen billed and received payment from Medicaid from July through November 2006 for care services for a developmentally delayed recipient that she did not provide. For further information contact Assistant Attorney General Aileen Miller (360) 5868888. Assisted Living Facilities: Florida Attorney General Bill McCollum announced on June 27 the arrest of Edwin Cintron for fraudulent billing to the Florida Medicaid program. Cintron is accused of submitting false Medicaid service logs for services not provided to a disabled recipient. The Florida Medicaid Fraud Control Unit was alerted to the fraudulent activities through its Operation Spot Check initiative, which facilitates surprise inspections of nursing homes and assisted living facilities to determine evidence of resident neglect or abuse. An investigation revealed that Cintron submitted false service logs showing he provided Medicaid services while he was working for a non-Medicaid employer. It was later determined that Cintron was reimbursed more than $38,000 by the Medicaid program for services he did not provide. The Agency for Persons with Disabilities assisted with the investigation. Cintron is charged with three counts of Medicaid fraud, a third-degree felony punishable by up to five years in prison and a $5,000 fine; and one count of scheme to defraud, a firstdegree felony punishable by up to 15 years in prison and a $10,000 fine. For further information contact Rick Lober, Director (850) 414-3600. Billing Agencies: Tennessee The Tennessee Bureau of Investigation announced that on July 18 Michael Prince, an owner of Prince Consulting Services and Infinity Associates, Inc., pleaded guilty to the first count of a sixty-three count indictment of conspiracy to commit wire fraud, healthcare fraud and payment of money for referral of patients. The court sentenced Prince to 25 months in prison, supervised release for three years and ordered him to pay restitution of $4,108,226.76 to the Centers for Medicare and Medicaid Services. This case was opened on November 21, 2000, based on information received from a defendant in another fraud case. It was alleged that Brittsen Rehabilitation was paying for referrals and billing Medicare for physical therapy conducted by unlicensed staff with no supervision by a licensed medical doctor. The investigation, which included agents from Health and Human Services ­ Office of Inspector General, Federal Bureau of Investigation and Internal Revenue Service ­ Criminal Investigation Division, showed that Prince's business functioned as the billing agency for Brittsen Rehabilitation as well as other rehab clinics. 3

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For further information contact Special Agent Roger Turner (901) 379-3432. Counselors: Texas Attorney General Greg Abbott announced on August 6 that Katherine Ferguson was indicted on 28 counts of healthcare fraud. Ferguson acted as a contract billing clerk for two counselors, and she allegedly intentionally double billed Medicaid claims for sessions provided by these counselors. A review of records provided by the first LPC showed that of the $116,380.85 Medicaid paid for the LPC's counseling services, $57,168.23 allegedly were payments for services not provided. A review of records provided by the second LPC showed that Medicaid paid $34,579.74 for that LPC's counseling services and that $16,751.63 was for services not provided. Each counselor paid Ferguson a percentage of all monies collected from Medicaid, and neither was aware that the double billing was taking place. **** Attorney General Abbott announced on August 22 that Debra Noel Smith, a licensed professional counselor and an independent contractor for Family Counseling Services, was sentenced to a 12 month term of imprisonment, a three year term of supervised release and restitution of $65,042.56 in federal court. On May 22, Smith pleaded guilty to health care fraud. Smith was indicted on August 15, 2007, by a federal grand jury on 24 counts of fraud. Twelve of the counts were for health care fraud and the remaining twelve counts were for false statements involving health care matters. The case originated when an LPC for Family Counseling Services contacted the Medicaid hotline to report that Compcare, the insurer for Medicaid managed care organization First Star, reported billing discrepancies from Smith. Smith had been billing Compcare for counseling services for a client and the client had reported not knowing Smith. Further investigation by the LPC revealed that Smith had billed for counseling for several families for which she did not provide services. For further information on both cases contact Rick Copeland, Director or Chief Investigator Jim Fossum (512) 371-4700. Denturists: Washington State Attorney General McKenna announced on June 10 that Ernie Hernandez pleaded guilty to one count First Degree Theft and three counts of Medicaid False Statement and was sentenced to 30 days in custody converted to 240 hours of community service and 24 months of community supervision. He was ordered to make restitution in the amount of $3,200 to the Medicaid program and to pay fines of $600. Investigator Jeff Oehlerich conducted the investigation and Assistant Attorneys General Andrea Jarmon and Lynn Mounsey handled the prosecution for the Washington State MFCU. During the course of his investigation he determined that Hernandez had contracted with DSHS to provide dentures and related-services to Medicaid patients. A DSHS audit revealed that 4

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Hernandez was not providing all of the dentures or all of the services for which he billed DSHS. Hernandez was paid $3,200 which he was not entitled to receive. For further information contact Assistant Attorney General Aileen Miller (360) 5868888. Drug Diversion: Texas Attorney General Abbott announced on July 15 that former certified nurse aide (CNA) Crystal Jackson was indicted on two counts of obtaining a controlled substance by fraud, each count a third-degree felony. Jackson allegedly ordered pain medications for residents without physician orders while employed at a nursing home. Jackson is alleged to have ordered hydrocodone from a pharmacy on seven separate occasions and subsequently diverted the medication upon its delivery to the facility. A total of 270 pills of hydrocodone were ordered between August 4 and August 28, 2007. **** Attorney General Abbott announced on August 20 that Regina Baca, a registered nurse, was sentenced in state court to two years deferred adjudication, fined $800, and ordered to surrender her nursing license and attend drug rehabilitation counseling. Baca pleaded guilty in May 2008 to one count of obtaining hydromorphone by fraud. Baca allegedly diverted 78 syringes of 4 mg. hydromorphone, brand name Dilaudid, from an automated Pyxis MedStation at Metropolitan Methodist Hospital over a four and one-half month period. Entry to the MedStation is made by a unique code and electronic fingerprint. It is alleged that Baca knowingly entered fictitious patient information and obtained the drugs without a doctor's order for her own use. For further information on both cases contact Rick Copeland, Director or Chief Investigator Jim Fossum (512) 371-4700. Durable Medical Equipment: Florida Attorney General McCollum announced on June 27 that Roman Arias was convicted of defrauding the Florida Medicaid program. He will serve five years in prison and must reimburse the state's taxpayers more than $225,000. In April, a jury found Arias, the owner of durable medical equipment company Expo Tech Services, guilty of grand theft and organized scheme to defraud the Medicaid program. Arias had fraudulently billed the state more than $250,000 for numerous orthopedic devices that he never purchased by using the names and Medicaid numbers of Medicaid recipients who neither needed nor received the equipment. The fraud continued over the course of a nine-month period and Arias was arrested in June 2006. Upon completion of his sentence, Arias will also serve 15 years probation. 5

Medicaid Fraud Report For further information contact Rick Lober, Director (850) 414-3600. Durable Medical Equipment: Texas

July/August 2008

Attorney General Abbott announced on July 2 that Anthony Etim, owner of a DME company, was sentenced in federal court to three years probation and ordered to serve 300 hours of community service. He was ordered to make restitution for the full paid amount of $1,030,000 pursuant to his guilty plea to health care fraud. Etim provided evidence used in the prosecution of four subjects in related DME cases, in which the subjects pleaded guilty. Etim, owner of Makey Medical Sales and Supply, paid $500-$1,100 to recruiters for fraudulent CMN's for Ensure and electric wheelchairs. The recruiters he identified were also DME providers in the Houston area who have since been convicted of health care fraud. From June 2000 through December 2002, Etim billed Medicare $1,500,000 and was paid $1,030,000. **** Attorney General Abbott announced on July 7 that Jesus Flores, owner of St. Mary's Ambulance Company, pleaded guilty in federal court to one count of conspiracy to commit health care fraud. The October 2007 indictment against Flores alleged that St. Mary's Ambulance Company was transporting non-emergency patients to area dialysis centers. The indictment also alleged that the company was providing incentives to patients for using the ambulance services. A superseding indictment was issued on July 1, alleging one count of conspiracy and eighteen counts of health care fraud. Between February 2004 and September 2005, Flores was paid $72,995.78 by Medicaid and $387,322.56 by Medicare for the six patients named in the indictment. **** Attorney General Abbott announced on July 18 that Eno Bassey Okon, owner of King's Medical Supply, was indicted on charges that he billed Medicaid/ Medicare for supplies that were not delivered, for supplies that were not medically necessary, and for supplies that were obtained using falsified certificates of medical necessity. Okon, through his company, allegedly delivered scooters and billed for wheelchairs, and/or made partial deliveries of adult diapers in a smaller size than were billed and paid for at a higher price. Between January 1, 2002, and August 18, 2006, Okon was paid $62,977.50 by Medicaid and $911,914.14 by Medicare. Of these amounts, fraud is suspected is $106,847.88. The Medicaid loss was $21,548.58. The Medicare loss was $85,299.30. **** Attorney General Abbott announced on July 28 that Theresa Peter was sentenced to 12 months in federal prison, three years of supervised probation, and restitution of $1,582,277 following her July 31, 2007, guilty plea to conspiracy to commit health care fraud, wire fraud and to paying illegal kickbacks. Peter and Udiak Wilson co-owned Access Medical Supply, a 6

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DME company. They were charged in a 35-count indictment on March 22, 2007, with Conspiracy, Health Care Fraud, Wire Fraud, Mail Fraud, Money Laundering Promotion, and Money Laundering Concealment. The charges stem from an alleged scheme to defraud Medicare and Medicaid by billing for motorized wheelchairs and delivering scooters. Wilson pleaded guilty on September 4, 2007. **** Attorney General Abbott announced on July 23 that Enohor V. Akarue has been sentenced to 15 years in prison for defrauding the Medicaid and Medicare programs. Akarue, former owner of Rosewood Medical Supplies, pleaded guilty in May to first-degree aggregate theft for his role in a false billing scheme. The guilty plea and sentencing came as a result of a joint investigation by the Houston FBI, the U.S. Department of Health and Human Services' Office of Inspector General and the Texas Attorney General's Medicaid Fraud Control Unit. The investigation scrutinized the suspect's Medicaid and Medicare billing records for wheelchairs that were either never delivered or not medically necessary. The evidence showed that Akarue billed Medicare and Medicaid from July 2002 through June 2003. The defendant is also charged with charging the government for expensive devices, but actually delivering much less expensive scooters to patients. The suspected overpayments to Akarue by Medicare are $564,000, with another $53,500 coming from Medicaid. **** Attorney General Abbott announced on July 28 that Caroline Inyang Rexti and Samuel Shekari, owners and operators of Nissi Medical Corporation, a durable medical equipment (DME) company, were indicted for theft by government contractor. It is alleged that Rexti submitted 1,612 claims against the accounts of 50 Medicaid recipients for incontinence supplies, of which $103,753.84 was identified through witness interviews as overpayments. Shekari allegedly handled delivery of the supplies and was the contact person for the billing company. The investigation showed that none of the recipients interviewed received any supplies from Nissi Medical Corporation and had never heard of the company. Most of the recipients did not need or use incontinence supplies, and those who did obtained their supplies from other vendors or purchased the supplies themselves. A review of records revealed that none of the doctor's signatures on the CMN's provided was authentic, indicating overpayments of $258,781. **** Attorney General Abbott announced on August 14 that Juan Avila, DME co-owner, pleaded guilty to Securing Execution of a Document by Deception in state court. Avila was sentenced to ten years probation and ordered to pay $40,000 in restitution. In May 2007, coowner Sergio Perez pleaded guilty to Medicaid fraud in state court. He was sentenced to three 7

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years probation and $8,000 in restitution. It was alleged that Perez and Avila, owners of La Paloma Medical Supply, were billing Medicaid for products not provided to recipients. The amount of fraud identified was $101,113.57. **** Attorney General Abbott announced on August 21 that Katherine West pleaded guilty in federal court to health care fraud and conspiracy to commit health care fraud. West is the owner of Odyssey Medical Supply & Counseling Center, a DME company. West allegedly supplied scooters to recipients and billed Medicaid/Medicare for wheelchairs. It is alleged that West was fraudulently paid $184,454.43 by Medicaid and $2,163,459.56 by Medicare of the total $2,347,913.99 paid to her. For further information on these cases contact Rick Copeland, Director or Chief Investigator Jim Fossum (512) 371-4700. Hearing Aids: Texas Attorney General Abbott announced on August 11 that George Harkey Dickson, a hearing aid fitter and dispenser pleaded guilty to one count of Medicaid fraud over $200,000 in state court and was sentenced to 90 days in jail, required to surrender his hearing aid fitter and dispenser license, placed on ten years probation, ordered to serve 1,000 hours of community service and to pay $700,000 in restitution. Dickson, owner of Dickson Hearing Aids Center, was charged for billing Medicaid for services not rendered and using unlicenced individuals to fit and dispense hearing aids and perform hearing tests on Medicaid recipients. Dickson operated out of a local flea market on weekends. From October 2005 through April 2007, Dickson was paid $928,950.98 by Medicaid, all of which was deemed to be fraud. For further information contact Rick Copeland, Director or Chief Investigator Jim Fossum (512) 371-4700. Home Health Care Agencies: Florida Attorney General McCollum announced on June 27 the arrest of two Timothy Timmer and Lisa Lewis for Medicaid fraud and grand theft. Timmer, an independent Medicaid provider, and his employee Lewis are accused of billing the Florida Medicaid program for services they never provided. Timmer is the owner and operator of Collier Connections, a service provider for the developmentally disabled. An investigation conducted by the Medicaid Fraud Control Unit revealed that Timmer billed the Medicaid program for patient services even though he was working for another employer at the time he claimed to be providing services. The investigation also revealed that Lewis signed activity logs indicating she was providing recipients with inhome services even though she was simultaneously working for another employer. Timmer is 8

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also charged with making ATM withdrawals from Medicaid recipients' bank accounts without their permission. For further information contact Rick Lober, Director (850) 414-3600. Home Health Aides: Kansas Attorney General Steve Six announced on July 3 that Betty Stroud was sentenced for her role in a scam to defraud the Kansas Medicaid program. Stroud was convicted of one felony count of Making a False Claim to the Medicaid Program and one felony count of Forgery. Stroud's husband was a Medicaid beneficiary and was enrolled to receive home health services under the Kansas Home and Community Based Services Program. Stroud submitted paperwork on behalf of her husband indicating that Carl Sutton had been employed as a personal care attendant for her husband. Between February and July of 2007, Betty Stroud did submit time sheets on behalf of Carl Sutton, indicating that personal care attendant services were provided when, in fact, no services had been provided. Moreover, Stroud had forged Sutton's signature without his knowledge or authorization. Upon receiving Sutton's checks from the Kansas Medicaid program, Betty Stroud would forge his endorsement on the back of the check and then cash the check and utilize the funds for her own personal benefit. Betty Stroud was sentenced to serve eight months, which was suspended, and ordered to pay restitution to the Kansas Medicaid program in the amount of $7,936.00. For further information contact Loren Snell, Director (785) 368-6220. Home Health Care Aides: Nevada Attorney General Catherine Cortez Masto announced on June 25 that Toni Griffin was sentenced for Medicaid Fraud. Griffin pleaded guilty to a gross misdemeanor offense of Failure to Maintain Adequate Records. District Court Judge Sally Loehrer sentenced her to 60 days in jail, suspended, ordered to pay $2,870 in restitution, penalties, and costs, and to serve three years probation, plus 16 hours of community service per month. MFCU Director Tim Terry, said the investigation began in 2007 after information was obtained that personal care aid services were not being provided to a Medicaid recipient. The investigation developed information that Griffin was not at patient's homes for the time periods she claimed to be providing services. For further information contact Mr. Terry (775) 684-1191. Home Health Care Aides: Texas Attorney General Abbott announced on August 19 that Paula Washington pleaded guilty in state court to a charge of Theft, greater than $1,500, but less than $20,000, and was sentenced 9

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to five years deferred adjudication and ordered to pay $12,064 in restitution. Washington allegedly falsified time sheets, while employed by Home Health Specialties, from November 2003 to March 2005. Home Health Specialties was paid $12,643.60 by Medicaid based on submitted billings. Washington was, in turn, paid $7,848.00 by Home Health Specialties based on the falsified time sheets. For further information contact Rick Copeland, Director or Chief Investigator Jim Fossum (512) 371-4700. Medical Transportation: Virginia Attorney General Bob McDonnell announced on August 22 that Mohamed Adam Abdelshafi was sentenced to 62 months in federal prison after being convicted of fifteen counts of Health Care Fraud and two counts of Aggravated Identity Theft on May 16. Abdelshafi, the owner and operator of Shafi Medical Transportation, LLC (Shafi Transportation), executed a scheme from November 30, 2006 through August 11, 2007 to defraud the Virginia Medicaid program by submitting inflated reimbursement claims that reflected more miles than actually traveled, submitting phantom reimbursement claims for trips which did not occur, and exploiting the names, dates of birth, and unique Medicaid identification numbers of recipients to establish legitimacy for the claims for reimbursement. During the period of the scheme, Abdelshafi caused the submission and payment of $308,329 in false claims on behalf of Shafi Transportation. Abdelshafi contracted with Virginia Premier Health Plan, Inc. (Virginia Premier), a Health Maintenance Organization contracted by Virginia Medicaid, to provide non-emergency transportation to Medicaid recipients. In July 2007, Virginia Premier audited Shafi Transportation's claims and identified unusually high amounts of mileage submitted for reimbursement. Virginia Premier referred the matter to the Virginia MFCU who investigated the case with the FBI and HHS-OIG agents. The United States Attorney's Office and MFCU prosecutors took the aggressive approach of charging Abdelshafi with Aggravated Identity theft related the phantom billings. By using the Medicaid recipients ID to further his criminal activity, it was alleged that Abdelshafi was guilty of Aggravated Identity theft. The United States District Court agreed and sentenced Abdelshafi to 38 months in prison for the Health Care Fraud counts and 24 months in prison for the Aggravated Identity theft counts, for a total of 62 months. Additionally, the Court ordered Abdelshafi to make full restitution for $308,329. Just over $260,000 was seized from Abdelshafi's bank account and that amount will be applied to restitution. Lastly, Abdelshafi will be subject to a deportation hearing once he has completed his prison sentence, as he is a foreign national from Sudan. For further information contact Chief Investigator Doug Johnson (804) 786-6495 or Assistant Attorney General Eric Atkinson (804) 692-0586.

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Medicaid Fraud Report Mental Health Services: Georgia

July/August 2008

Attorney General Thurbert Baker announced on August 11 that Tina Webster-Fabayo entered guilty pleas to two counts of Medicaid fraud in the county state superior court and was sentenced to five years' incarceration, followed by 15 years probation, and a fine of $1000. Webster-Fabayo owned and operated two mental health service companies, Med Path Professional Services and One Youth House from late 2004 through 2007. The indictment, returned on March 27 of this year, charged that Webster-Fabayo engaged in a fraudulent scheme, involving the submission of numerous fraudulent claims submitted under the provider numbers of a psychiatrist, two psychologists and a social worker. These providers were not charged and cooperated with the investigation. Webster-Fabayo's scheme included billing for numerous services which were not rendered to patients, as well as "double-billing" Medicaid for services provided to adolescents that were paid for through a contract with the Georgia Department of Juvenile Justice. The indictment charged that during a two-day period in April, 2007, while clinic employees were on a company retreat, received massages and sky dived, the Medicaid program paid Med Path over $15,000 for clinical services not rendered. The estimated loss to the State of Georgia exceeded $2 million. For further information contact Senior Assistant Attorney General Scott A. Smeal (770) 414-3655 ext 216. Nurses: Minnesota Attorney General Swanson reported on July 31 that the license of registered nurse (RN) Adetoun Olufadebi Coker was revoked. Coker was employed by All Home Caring to provide RN supervision of home health aides (HHAs). Many of Coker's clients were Russian speaking and required the services of a Russian interpreter. Coker frequently used certified Russian interpreter Adela Kazaniuk. Kazaniuk was previously prosecuted for Medicaid fraud by the Minnesota Medicaid Fraud Control Unit. During the period of March 2004 through January 2005, Coker submitted false RN supervisory reports to All Home Caring claiming that she provided RN supervision of HHAs when the HHAs were working at another job. During the month of January 2005, Coker verified Kazaniuk's timecards for interpreter services that were submitted to the interpreter agency. She could not have provided the interpreter services because she was out of the country. Coker was charged and pleaded guilty to felony theft by false representation. Coker was placed on probation for a period of five years with the conditions that she pay restitution to the prepaid medical assistance plan in the amount of $9,628.39, perform 100 hours of community service within one year and pay prosecution costs in the amount of $829. In addition, Coker may not be employed at any facility that receives medical assistance.

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This matter was referred to the Minnesota Board of Nursing for its consideration of licensing action. It revoked her license on July 31, 2008 based on this conviction. For further information contact Assistant Attorney General Gina Jensen (651) 297-1093. Nurses: Virginia Attorney General McDonnell announced on July 21 that the largest prosecution of a personal care agency in Virginia ended in guilty pleas in federal court on July 18. Rina Zavelsky, a nurse, and her company, Renaissance Inc., pleaded guilty to one count of conspiracy to commit health-care fraud. Rina Zavelsky is facing a maximum of ten years in prison and a $250,000 fine. The company faces a fine of up to $500,000. As part of the plea agreement, Ilya Zavelsky, a physician and Zavelsky's husband, was dismissed from the case. Their company provided personal care and respite care to Russian-speaking Medicaid recipients throughout Virginia. They were indicted this year for conspiracy to commit health-care fraud and money laundering. In pleading guilty, Rina Zavelsky admitted she defrauded Medicaid by submitting false claims for payment. She acknowledged providing services through unqualified and untrained personal care aides and making false training certificates to cover up the lack of training. From 2002 to its closing in 2008, Renaissance employed more than 350 aides acting as independent contractors. It submitted billings for more than 250 Medicaid recipients in the Richmond, Tidewater, Harrisonburg and Northern Virginia areas. Total billings for Renaissance to Virginia Medicaid totaled more than $14 million. For further information contact Senior Investigator Michele Bruno (804) 692-0482. Nursing Assistants: Oregon Attorney General Hardy Myers announced on July 21 that Deborah L. Godfrey, a certified nursing assistant, was convicted of one felony count of Submitting a False Claim for Health Care Payment. Godfrey submitted a voucher for payment to the Oregon Department of Human Services claiming that she provided in-home care to her mother, a Medicaid client, when she did not, after her mother was admitted to a nursing home. Washington County Circuit Court Judge Donald Letourneau sentenced Godfrey to five days in jail, 36 months of probation and ordered her to serve 160 hours of community service. She is prohibited from being employed in any capacity paid with Medicaid and/or Medicare dollars and prohibited from employment where she has access to elderly or dependent persons. She was ordered to pay fines and $2,687.68 in restitution. For further information contact Assistant Attorney General Sheen Y. Wu (971) 673-1880. 12

Medicaid Fraud Report Nursing Homes: Virginia

July/August 2008

Attorney General McDonnell announced on August 22 that Cora Mae Lane was sentenced in Southampton Circuit Court to18 years with all but 10 months suspended. The case was originally referred because a Virginia Department of Medical Assistance Services audit found whiteout alterations to the patient pay amounts on DMAS-122 forms at Courtland Healthcare Center. The fraud theory was that an employee was likely whiting out the patient pay amount and changing it to zero, then collecting payment from the residents at Courtland and pocketing the money. Virginia MFCU auditors investigated and determined that Lane, business office manager for Courtland Healthcare, was the person responsible for the 122 alterations. However, when interviewed, the target denied any knowledge or involvement. To add to the difficulty, Courtland Healthcare and its parent company Medical Facilities of America (MFA) came to Lane's defense. They insisted that she was not responsible for any wrongdoing and aided in her defense by entering into a Joint Defense Agreement between Lane and MFA. MFCU auditors were convinced that Lane was engaging in fraudulent conduct and they were determined to put a case together. While researching Lane's personal finances they discovered an unusually high number of check deposits from MFA/Courtland Healthcare. It was determined that they were written to reimburse Lane for work-related travel. They followed up by requesting the travel vouchers from MFA that corresponded with each reimbursement check. The travel vouchers revealed that Lane claimed to travel to DSS offices all over Virginia for "Medicaid reviews". The auditors traveled to each of the DSS offices that Lane claimed to have visited. During their investigation, they collected sign-in logs and interviewed DSS witnesses. What they found was that Lane had never made the trips she claimed to make. In addition, they researched the actual amount of miles on Lane's car by reviewing maintenance records held by her mechanic as additional proof that she had not actually traveled the miles she claimed on reimbursement vouchers. Upon learning of this scheme, MFA immediately severed the joint defense agreement and began to cooperate with the investigation. Lane was indicted for submitting phony travel reimbursement vouchers to Courtland Healthcare Center for work-related travel. On June 12, 2008, Lane entered guilty pleas to three counts of obtaining money by false pretenses. For further information contact Kristine Asgian, Chief Auditor (804) 786-3352. Nutritionists: Maryland Attorney General Douglas F. Gansler announced on July 15 that Olusola Idowu, a nutritionist, was found guilty by a jury of Medicaid Fraud and related offenses for routinely billing as if a doctor performed services when she knew no doctor was involved. Idowu testified on her own behalf and was convicted on all charges.

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From March, 2002 through March, 2006, Idowu was the owner and lone nutritionist at SSS Nutrition Services, also known as Healthy You Nutrition Services, LLC. Despite the fact that she is not and never has been a doctor, Idowu routinely billed Amerigroup, a Medicaid agent, and three private insurers using the highest paying office visit billing code reserved only for doctors performing consultations. Idowu used that code hundreds of times to bill for services she performed, telling the insurers that she saw each client for 80 minutes per visit even though the visits were generally 30 minutes or fewer. She used the initial consultation code, which is paid much higher than regular office visits, even for clients who came for follow-up services. The proper code for nutritional services performed by a nutritionist paid about $15 for a 15 minute session. By billing fraudulently, Idowu received between $177 and $186 for as little as 15 minutes of services. The total loss caused by Idowu's fraud exceeds $175,000. For further information contact Assistant Attorney General Richard Bardos (410) 5766533. Oxygen Suppliers: Massachusetts Attorney General Martha Coakley's Office announced an agreement with a home oxygen supplier to settle allegations of improper billing practices. Home Care Specialists, Inc. (Home Care Specialists), has agreed to pay $118,524 to the state's Medicaid Program. The settlement follows an investigation by the Attorney General's Office after an audit of Home Care Specialists billing records. Investigators discovered that between 1996 and 2006 the company engaged in improper billing practices which resulted in overpayments by the Massachusetts Medicaid Program (MassHealth), a program providing comprehensive health care benefits to some of the Commonwealth's neediest citizens. The settlement requires Home Care Specialists to repay the overpayments, with interest, and submit to a one-year program of internal audits and reviews by an independent auditor. Home Care Specialists provides oxygen services and supplies to patients in their own homes and to those living in nursing homes. These services included the rental of necessary equipment and the pick-up and delivery of oxygen tanks. The investigation revealed that the company improperly billed for: pieces of equipment separately that should have been billed as one piece of equipment; equipment that was no longer medically necessary; and items and services at rates higher than those approved by MassHealth. For further information contact Assistant Attorney General David R. Marks, Investigator John Walsh and Data Analyst Anthony Megathlin (617) 727-2200. Patient Abuse: District of Columbia The District of Columbia Medicaid Fraud Control Unit announced on June 16 that Jefferson Weeden was sentenced on June 4 in superior court, in connection with his non14

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consensual touching of a vulnerable adult. Weeden pleaded guilty to one count of Misdemeanor Sexual Abuse in November 2007. Weeden worked as a driver for a transportation company, and the vulnerable adult was in his care while he transported her to a day program for adults with cognitive challenges. In February 2007, after picking the woman up at her home, Weeden took her to his apartment, showed her a pornographic video and sexually assaulted her. He then drove her to her day program. Several days later, the woman informed staff at her day program about what Weeden had done to her, which was subsequently reported to the D.C. Office of the Inspector General, Medicaid Fraud Control Unit. Citing the egregious breach of public trust, Weeden was ordered to serve 20 days in jail. For further information contact Criminal Investigator Vantresse McMillan or Investigative Assistant Victor Richardson (202) 727-5876. **** The District of Columbia Medicaid Fraud Control Unit announced on June 27 that Willie Eubanks, a former counselor at the National Children's Center (NCC), a residential facility for individuals with developmental disabilities, has been has been found guilty and sentenced for assaulting a minor child who resides at the facility. On June 24, Eubanks, pleaded guilty to one count of Simple Assault. Eubanks was sentenced to 180 days in prison, all but 45 days suspended and two years of supervised probation. Eubanks was also ordered to undergo anger management and drug testing. Eubanks was ordered to stay away from the facility, the minor child, and all minor children under the age of 18. In addition, Eubanks was ordered to pay $100 to the Victims of Violent Crime Compensation Fund. According to the government's evidence, on September 30, 2007, staff took the victim and other residents of NCC on a community outing to the Kennedy Center for Performing Arts (Kennedy Center). Two Kennedy Center security guards witnessed Eubanks strike the child multiple times on his neck, back, and stomach while he was seated on an NCC bus parked in the Kennedy Center parking lot. When confronted by the security guards, Eubanks told them he was disciplining the child for misbehaving in the Kennedy Center. For further information contact Criminal Investigator Allen Johnson (202) 757-5923. Patient Abuse: Iowa The Iowa Medicaid Fraud Control Unit announced on July 18 that Julia Jernia Jamieson, AKA Johnson, certified nurse aide, pleaded guilty in county district court to one count of Wanton Neglect. Jamieson admitted to placing a washcloth in the mouth of a resident while she was giving the resident a shower at the care facility. Jamieson received a deferred judgment, 15

Medicaid Fraud Report

July/August 2008

probation for one year, and was ordered to pay $725 in fines and costs. She was placed on the Iowa abuse registry, and reported to OIG Office of Exclusions and the NHPDB. For further information contact Dan Hoffa, Director (515) 281-4291. Patient Abuse: Texas Attorney General Abbott announced on August 4 that Loretta Lynn Benavidez, a certified nurse aide, pleaded no contest to the two charges for injury to an elderly or disabled individual, a state jail felony. Benavidez worked for Rockport Coastal Care Center Nursing Home. Allegedly, during April through May 2007, Benavidez physically assaulted and verbally abused two residents. **** Attorney General Abbott announced on August 7 that grand jury indicted service assistant Dionicia Marie Monroy for injury to a disabled individual. It is alleged that Monroy, while employed at the Abilene State School, struck a disabled resident in the face with a chair causing bodily injury. For further information on both cases contact Rick Copeland, Director or Chief Investigator Jim Fossum (512) 371-4700. Patient Trust Funds: Alabama Attorney General Troy King announced on July 11 that Anne Marie Jones, convicted for the theft of $97,036 while employed as an accounts payable clerk at South Haven Nursing Home, has been sentenced to serve three years in state prison. Jones pleaded guilty on April 30 to two counts of first-degree theft and one count of second-degree criminal possession of a forged instrument. Jones was sentenced to 10 years imprisonment, with three years to serve on a split sentence with five years of supervised probation upon her release from prison, and ordered to pay restitution in the amount of $97,036. The matter was brought to the attention of the Alabama Medicaid Fraud Control Unit by South Haven Nursing Home's management after they discovered discrepancies in the facility's patient trust fund. A subsequent investigation conducted by the Medicaid Fraud Control Unit and the Montgomery Police Department determined that from September 2005 to April 2007, Jones wrote checks on the nursing home's patient trust fund and represented that the money was being used for residents' personal needs. Jones was actually cashing the checks and depositing the proceeds into her personal bank account. Jones also intercepted numerous checks mailed to the facility for the benefit of residents and deposited those checks into her personal account as well. 16

Medicaid Fraud Report

July/August 2008

Upon discovering the theft, the nursing home reimbursed the patients' accounts for the amounts stolen. For further information contact Bruce Lieberman, Director (334) 353-8793. Patient Trust Funds: Iowa The Iowa Medicaid Fraud Control Unit announced on July 11 that Calvin Pearson, a certified nurse aide, pleaded guilty in county district court to one count of forgery and one count of theft in the Second Degree. Pearson, while visiting a facility that he did not work at, stole blank checks from two facility residents. Pearson subsequently cashed checks, committing forgery, and used checks to purchase goods and services for himself, committing theft. Pearson was sentenced to serve 60 months in jail, suspended, and placed on 36 months probation. He was ordered to pay restitution of $7,596.34 and pay costs and fines totaling $2,720.00. He was reported to the Iowa abuse registry and the NHPDB. As the crime occurred in a facility where Pearson did not work, meaning he was not a caregiver to the victims, the matter was not reported to OIG Office of Exclusions. For further information contact Dan Hoffa, Director (515) 281-4291. Patient Trust Funds: Missouri Attorney General Jay Nixon announced on July 2 that Tammy Lynn Dudley was convicted on criminal charges that she forged checks in order to steal money from the resident trust fund account of the nursing home where she was the bookkeeper. Dudley pleaded guilty to one count each of forgery, stealing by deceit, and abuse of a person receiving health care by taking of funds. The victims were Medicaid recipients who were residents at the Mark Twain Caring Center. Circuit Judge Stephen R. Sharp sentenced Dudley to seven years on each count, to run concurrent. The judge suspended execution of sentence and placed her on five years supervised probation. Dudley also was ordered to pay restitution in full of $47,561.47 in monthly installments of no less than $800. The investigation by the Medicaid Fraud Control Unit showed that, between April 2005 and February 2006, Dudley misappropriated money through checks allegedly signed by residents after their date of death, and through checks made payable to a resident when the checks should have been payable to the nursing home as surplus funds. All of the checks were cashed for cash. For further information contact Rick Williams, Director (573) 751-7192.

17

Medicaid Fraud Report Patient Trust Funds: Oregon

July/August 2008

Attorney General Myers announced on July 16 the conviction and sentencing of Linda A. Patt on numerous elder abuse charges related to when Patt was a manager for several group homes. Patt was convicted of two counts of felony Criminal Mistreatment in the First Degree and sentenced by the county circuit court. Patt worked for two years as house manager for several group homes. In that capacity she was also responsible for residents' funds. In 2007, an in-house audit revealed that numerous residents' accounts were missing funds. A referral was made to the local law enforcement and the Oregon Medicaid Fraud Control Unit. It was determined that Patt took funds from residents' accounts and also made personal purchases using residents' checks. As a result of the convictions, Patt was sentenced to 45 days jail and placed on five years of supervised probation. Conditions of probation include having no contact with the residents she defrauded, pay fees and fines of $1,346, and restitution totaling $10,713.72. For further information contact Senior Assistant Attorney General Rodney K. Hopkinson (971) 673-1880. Patient Trust Funds: South Dakota Attorney General Larry Long announced on July 29 that Bradley Dean Dooley was sentenced to serve four years in prison for stealing money from his elderly aunt. Dooley pleaded guilty in June to one count of Embezzlement. Dooley has already paid restitution of three hundred and fifty thousand dollars as part of his plea agreement. Dooley's aunt, Zelpha Faughender made Dooley her Power of Attorney for financial affairs. Dooley used the power of attorney to write checks on Faughender's account without her authorization. For further information contact Paul Cremer, Director (605) 773-4102 Patient Trust Funds: Texas Attorney General Abbott announced on August 20 that Jacquelyn Jones Phillips was ordered to pay $72,000 in restitution. Phillips, the former bookkeeper, could not provide any supporting documents to prove her claims of payments to other parties. Phillip was ordered to pay $500 per month, and the judge reset the case in one year to see how she complies with this order. On February 25, Phillips was sentenced to five years probation and assessed a fine of $100 as terms of her deferred adjudication of guilt, with the restitution ordered to be determined. Phillips allegedly stole more than $72,000 from patient trust fund accounts from about 2004 through November 2006. The alleged theft was discovered during a Department of Aging and Disability Services survey of the facility in November 2006. 18

Medicaid Fraud Report

July/August 2008

For further information contact Rick Copeland, Director or Chief Investigator Jim Fossum (512) 371-4700. Personal Care Attendants: Kansas Attorney General Six announced on August 5 that Jay Thompson and Mike Hix were sentenced for their roles in a conspiracy to commit Medicaid Fraud. Mike Hix, a Medicaid beneficiary, and Jay Thompson, a personal care attendant under the Kansas Home and Community Based Services Program, conspired to create and submit time sheets claiming reimbursement for services that were not provided. In fact, Thompson was employed as a truck driver during the time he reportedly provided care to Hix, and was not providing any care to him. Upon receiving checks for Thompson, Hix and his wife would deposit the funds in to a joint account with Thompson, and would immediately withdraw the funds. When Thompson would come to town for a visit, Hix would give him a portion of the funds received. The total amount of overpayments as a result of these activities was $48,908. Thompson was sentenced to 14 months in the Department of Corrections and placed on probation, and was ordered to pay restitution to the Medicaid program. Hix was sentenced to six months, placed on probation, and ordered to pay restitution. For further information contact Loren Snell, Director (785) 368-6220. Pharmacists: Kentucky Attorney General Jack Conway announced on July 23 that a grand jury has returned a six-count felony indictment against Eric Grider, a pharmacist, for allegedly engaging to defraud the Kentucky Medicaid Program. Grider was indicted on July 23. According to the indictment, Grider allegedly defrauded the Kentucky Medicaid Program by submitting fraudulent claims for prescriptions. The indictment alleges Grider billed Medicaid for a different drug than was given to the client. For further information contact Tad Thomas, Acting Director (502) 696-5489. Physicians: District of Columbia The District of Columbia Medicaid Fraud Control Unit announced on June 27 that Mansour Salahmand was indicated by a federal grand jury on numerous charges for pretending to be a licensed physician and stealing the names and identification numbers of doctors. Salahmand was charged in an eleven-count indictment with four counts of identity theft, three counts of unlawful use of another person's DEA number in the dispensing of a controlled substance, and four counts of forgery. According to the indictment, Salahmand was not a licensed physician and not authorized by the District of Columbia, Maryland, or the DEA to write prescriptions for controlled substances. Nonetheless, Salahmand tricked multiple mental health clinics into hiring him as a medical doctor, that is, a psychiatrist. Salahmand falsely told 19

Medicaid Fraud Report

July/August 2008

various clinics that certain doctors would be supervising him, when, in fact, the doctors had not agreed to do so. Once hired, Salahmand pretended to be a licensed doctor and allegedly forged four different doctors' names and used their DEA authorization numbers without their permission to write prescriptions for controlled substances. The indictment further alleges that Salahmand obtained the doctors' names and DEA authorization numbers by working at some of the same clinics which had previously employed the doctors. Salahmand even created and used fake prescription pads with the names and DEA numbers of three of the four doctors without the doctors' knowledge or permission. During the course of the fraud, from August 2004 to October 2006, Salahmand allegedly tricked more than seven mental health clinics into hiring him, and wrote over 150 prescriptions for Schedule II and Schedule IV controlled substances forging the names of the doctors. For further information contact Criminal Investigator Sandra Adams (202) 757-5866. Physicians: Texas Attorney General Abbott announced on August 21 that Roderick Lee Mitchell, MD, was indicted on one count theft at a felony three level. Dr. Mitchell allegedly billed Medicaid for long-term care facility visits that exceeded 24 hours a day, after seeing other patients in his medical clinic on the same days. Dr. Mitchell also billed for services he allegedly provided on days when he was out of town. From December 2002 through August 2006, the total overpayments identified were $544,368.05 including $129,159.08 from Medicaid and $415 208.97 from Medicare. For further information contact Rick Copeland, Director or Chief Investigator Jim Fossum (512) 371-4700. Resident Neglect: District of Columbia The District of Columbia Medicaid Fraud Control Unit announced on August 15 that Marlo Chaney, a former direct care giver, who worked for RCM of Washington, Inc. (RCM), which operated a residential group home for individuals with developmental disabilities, has been found guilty and sentenced for criminal neglect of a 54-year-old vulnerable adult in March. On August 12, Chaney pleaded guilty to one count of Criminal Negligence in superior court. Chaney was sentenced to 180 days in prison, all suspended, and two years of supervised probation. Chaney was also ordered to undergo drug testing and treatment. Chaney is prohibited from working with vulnerable populations, such as the disabled, elderly, and children. In addition, Chaney was ordered to perform 16 hours of community service and was specifically advised that such service could not be with vulnerable populations. She also was ordered to pay $50 to the Victims of Violent Crime Compensation Fund.

20

Medicaid Fraud Report

July/August 2008

According to the government's evidence, on March 1 the defendant was employed as a support associate with the responsibility of caring for vulnerable adults diagnosed with severe mental retardation. Another care giver present at the group home saw the defendant dragging the victim on a carpeted floor in the group home causing a carpet burn injury to his right thigh. For further information contact Investigator Jonathan Rich (202) 757-5864. Social Workers: Maryland Attorney General Gansler announced on July 11 that Tammy D. Smith and her husband, Anthony Smith were each sentenced to two years incarceration as a result of their convictions of conspiracy, felony Medicaid fraud, and theft. Circuit Court Judge John F. Fader also ordered the couple to pay restitution to the State Medicaid Program in the amount of $783,653. The evidence in the case established that Tammy Smith, a licensed social worker, and her husband, who handled her billing, submitted thousands of false claims to the Maryland Medicaid program for therapy services that were not performed at all or were different from the services billed for. For example, Tammy Smith billed for services she claimed to have performed on several days when she was a hospital inpatient. She also billed for nine months of multiple therapy services a week for a patient she never saw and who was in the hospital at the time the services were allegedly rendered. The state established that from January, 2000 through December, 2003, Medicaid paid the Smiths nearly $900,000. The Smiths failed to document over $700,000 of those services, although required to do so by the Medicaid regulations. For further information contact Michael J. Travieso, Director or Assistant Attorney General Thomas W. Rafter (410) 576-6529. Speech Therapists: Arkansas Attorney General Dustin McDaniel announced on August 4 that Anna Walthall was sentenced to six years in prison with three suspended on the condition that she pay over $68,000 in restitution to the State of Arkansas. Walthall also must pay a fine of over $205,000. A month prior to sentencing, the defendant entered a guilty plea to one count of Medicaid Fraud and one count of Failure to Maintain Records. Between August of 2004 and May of 2006, the defendant billed Medicaid for providing services that had not been ordered by a physician. The defendant was in possession of forged referrals and had represented those referrals as authentic when she was audited by the Arkansas Foundation for Medical Care. She used those forged referrals as a basis for billing Medicaid for providing speech therapy. For further information contact Jay Shue, Director (501) 682-2007.

21

Medicaid Fraud Report CASE UPDATES Nursing Homes: Texas

July/August 2008

Attorney General Abbott announced on July 30 that Stephen Mi Chael Ewing was sentenced to ten years incarceration on multiple counts including conspiracy to defraud the government by obstructing and impeding lawful government functions of the Internal Revenue Service and Department of Health and Human Services, tax evasion, mail fraud, false statement to a government agency, and false statement relating to a health care matter. Upon release, Ewing will be on supervised release for three years. The court ordered $11,654,239 in restitution; $3,496,271.70 to the Medicare program and $8,157,967.30 to the Medicaid programs. Gary Trebert, Larry May and Ewing were indicted on 29 counts on March 14, 2007, the charges range from conspiracy to commit fraud, tax and healthcare fraud, to mail fraud (See: Medicaid Fraud Report, March/April 2007, p. 20). Trebert, Ewing and May were the owner/operators of approximately 70 nursing facilities located in five states. From January 1999 through May 2004, it is alleged that they conspired to defraud the IRS of approximately $34 million, largely generated from income received from Medicare/Medicaid programs. Other allegations for the same time period include: failure to provide accurate and complete information to state/federal regulatory agencies; failure to pay vendors, employees, and utilities of the nursing homes; and, placing nursing home residents at risk for these failures. The overall fraud amount is determined at $189,524,722.57. Approximately $110,411,659.63 of this amount comes from the Texas Medicaid program and the balance from the Medicare program and private payers. Ewing was found guilty by a federal jury on May 7, 2008. May pleaded guilty last year, and was sentenced four years in federal prison. Trebert pleaded guilty February 27, 2008. **** Attorney General Abbott announced on August 11 that Gary Raywood Trebert was sentenced in federal court to 60 months for count one of conspiracy to defraud the government by obstructing and impeding lawful government functions of the Internal Revenue Service and Department of Health and Human Services, and to 12 months for tax evasion, aiding and abetting. The sentences are to be served consecutively. Upon release, Trebert will be on supervised release for three years. He was also ordered to pay $11,654,239 in restitution to Medicare and Medicaid. This is the final sentencing in a major nursing home fraud case. Trebert, Stephen Michael Ewing and Larry Gordon May were indicted by a federal grand jury in March 2007 on a 29-count indictment for conspiring to defraud the IRS and HHS, tax evasion, mail fraud, false statements to a governmental agency and false statements in a healthcare matter (See: Medicaid Fraud Report, September/October 2007, p. 17). Ewing was found guilty by a federal jury and sentenced in July 2008 to 120 months in a federal penitentiary and 36 months probation. Ewing was also ordered to pay $11,654,239 in restitution. May plead guilty in October 2007, and was sentenced to four years, which he is currently serving, plus two years probation. From January 1999 through May 2004, it was alleged that the subjects conspired to 22

Medicaid Fraud Report

July/August 2008

defraud the IRS of approximately $34 million, largely generated from income received from the Medicare/Medicaid programs through approximately 70 nursing facilities located in five states. The overall fraud amount was $189,524,722.57. Approximately $110,411,659.63 of this amount came from the Texas Medicaid program and the balance from the Medicare program and private payers. For further information on both cases contact Rick Copeland, Director or Chief Investigator Jim Fossum (512) 371-4700. Occupational Therapists: Texas Attorney General Abbott announced on August 13 that Albert C. Albert, an occupational therapist, was sentenced to 15 years in prison for defrauding the Medicare and Medicaid programs. Albert pleaded guilty in May to first-degree felony theft by a governmental contractor for billing the government health care programs for services he never rendered. According to state investigators, between February 1999 and February 2004, Albert's occupational therapy clinics, Skillcare Rehabilitation Services and Nelbat Rehabilitation Services, received fraudulent Medicare and Medicaid reimbursements totaling more than $170,000. In addition, Albert billed Medicare/Medicaid almost $55,000 for services dated after the death of 34 patients. Albert was indicted for first-degree felony theft last October (See: Medicaid Fraud Report, May/June 2008, p. 13). Investigators detected the fraudulent payments among almost $1.3 million paid to the occupational and physical therapy clinics operated by Albert. Interviews with 33 patients resulted in information showing that most of them never received the treatments alleged in Albert's billings to the government.

For further information contact Rick Copeland, Director or Chief Investigator Jim Fossom (512) 371-4700.

23

Medicaid Fraud Report Inquires on editorial content should be addressed to:

July/August 2008

Barbara L. Zelner Counsel National Association of Medicaid Fraud Control Units 2030 M Street NW, 8th Floor Washington, D.C. 20036 [email protected] Lawrence Wasden President National Association of Attorneys General Idaho Jeffrey S. Cahill President National Association of Medicaid Fraud Control Units James McPherson Executive Director National Association of 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 2008, National Association of Attorneys General

24

Medicaid Fraud Report INDEX TO CASES

July/August 2008

ADULT FAMILY HOMES .....................................................................................................2 ASSISTED LIVING FACILITIES .........................................................................................3 BILLING AGENCIES..............................................................................................................3 COUNSELORS Katherine Ferguson....................................................................................................................4 Debra Noel Smith ......................................................................................................................4 DENTURISTS ...........................................................................................................................4 DRUG DIVERSION Regina Baca ...............................................................................................................................5 Crystal Jackson ..........................................................................................................................5 DURABLE MEDICAL EQUIPMENT Enohor V. Akarue ......................................................................................................................7 Roman Arias ..............................................................................................................................5 Juan Avila ..................................................................................................................................7 Anthony Etim.............................................................................................................................6 Jesus Flores ................................................................................................................................6 Eno Bassey Okon.......................................................................................................................6 Theresa Peter..............................................................................................................................6 Caroline Inyang Rexti and Samuel Shekari ...............................................................................7 Katherine West...........................................................................................................................8 HEARING AIDS.......................................................................................................................8 HOME HEALTH CARE AGENCIES ...................................................................................8 HOME HEALTH CARE AIDES Toni Griffin................................................................................................................................9 Betty Stroud ...............................................................................................................................9 Paula Washington ......................................................................................................................9 MEDICAL TRANSPORTATION ........................................................................................10 MENTAL HEALTH SERVICES..........................................................................................11 NURSES Adetoun Olufadebi Coker ........................................................................................................11 25

Medicaid Fraud Report

July/August 2008

Rina Zavalsky ..........................................................................................................................12 NURSING ASSISTANTS.......................................................................................................12 NURSING HOMES Stephen Mi Chael Ewing .........................................................................................................22 Cora Mae Lane.........................................................................................................................13 Gary Raywood Trebert ............................................................................................................22 NUTRITIONISTS...................................................................................................................13 OCCUPATIONAL THERAPISTS .......................................................................................23 OXYGEN SUPPLIERS ..........................................................................................................14 PATIENT ABUSE Loretta Lynn Benavidez...........................................................................................................16 Willie Eubanks.........................................................................................................................15 Julia Jernia Jamieson................................................................................................................15 Dionicia Marie Monroy ...........................................................................................................16 Jefferson Weeden.....................................................................................................................14 PATIENT TRUST FUNDS Bradley Dean Dooley...............................................................................................................18 Tammy Lynn Dudley...............................................................................................................17 Anne Marie Jones ....................................................................................................................16 Linda A. Patt ............................................................................................................................18 Calvin Pearson .........................................................................................................................17 Jacquelyn Jones Phillips ..........................................................................................................18 PERSONAL CARE ATTENDANTS ....................................................................................19 PHARMACISTS .....................................................................................................................19 PHYSICIANS Roderick Lee Mitchell, MD.....................................................................................................20 Mansour Salahmand.................................................................................................................19 RESIDENT NEGLECT .........................................................................................................20 SOCIAL WORKERS .............................................................................................................21 SPEECH THERAPISTS ........................................................................................................21 26

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