MEDICAID FRAUD
REPORT
National Association
of Medicaid Fraud Control Units
July/August 2012
INSIDE
Home Health Care Owner Convicted
for Defrauding D.C. Medicaid Program........................... 1
Cases................................................................................. 2
Case Updates ................................................................... 20
Home Health Care Owner Convicted for Defrauding D.C. Medicaid Program
The District of Columbia Medicaid Fraud Control Unit announced on July 13 that
Jacqueline Wheeler, the Chief Executive Officer and owner of two health care companies, was
convicted by a federal jury of one count of health care fraud and 34 counts of false statements
for submitting more than $7 million in fraudulent claims to the D.C. Medicaid program.
Wheeler was convicted following a trial in the U.S. District Court for the District of
Columbia. She faces a maximum sentence of 10 years in prison and a $250,000 fine for the
health care fraud conviction and five years in prison and a $250,000 fine for each of the false
statements convictions. The judge ordered that Wheeler be jailed pending sentencing.
According to the government’s evidence, Wheeler was the chief executive officer of
the Health Advocacy Center, Inc. She was also the owner of Sheridan Rehabilitative and
Wellness Centers, Inc., a private company located at the same address.
Beginning in January 2006 and continuing through April 2008, Wheeler, through the
Health Advocacy Center, submitted false claims for services that were not provided. She
collected at least $2.6 million before the activities were detected. Evidence showed that she
used the proceeds of her fraud to support the purchase of four luxury vehicles, two
beachfront properties in Florida, and her home.
The Health Advocacy Center was purportedly engaged in serving as an advocate for
improved health care delivery to the community. Specifically, it provided management
support, as well as financial advice and assistance to other health care providers. It was a
registered District of Columbia Medicaid provider.
Sheridan Rehabilitative and Wellness Centers was purportedly engaged in providing
rehabilitative services to the mentally and physically disabled community, offering housing to
mentally and physically challenged individuals.
Medicaid Fraud Report
July/August 2012
The company was not an authorized D.C. Medicaid provider. Wheeler was a registered
naturopath with the District of Columbia Department of Health, Health Professional Licensing
Administration. However, she was not a licensed medical doctor. Wheeler did work with a licensed
medical doctor, who was a part-owner of the Health Advocacy Center. This doctor’s specialty was
physical medicine and rehabilitation. As a result of Sheridan Rehabilitative and Wellness Centers not
being authorized as a D.C. Medicaid provider, it was unable to submit bills to D.C. Medicaid.
From January 2006 through April 2008, Wheeler prepared and submitted all of the billing for
the Health Advocacy Center, and handled all financial matters for both the Health Advocacy Center
and Sheridan. During that time period, Wheeler submitted over 600 claims to D.C. Medicaid for
manual therapy services that the Health Advocacy Center purportedly provided to approximately 22
District of Columbia Medicaid beneficiaries. In these claims, she maintained that the Health Advocacy
Center provided in excess of 20 continuous hours of manual therapy for each patient in a single 24hour period, and sought over $6.5 million from D.C. Medicaid for manual therapy services. In
performing therapeutic procedures such as manual therapy, the health care provider is required to bill
in 15-minute intervals or units. There are only 1,440 minutes in a day. However, Wheeler routinely
billed D.C. Medicaid from 1,440 continuous minutes of manual therapy for a single patient in a 24-hour
period to as many as 2,910 continuous minutes (or 48.5 hours) of manual therapy for a single patient
in a 24-hour period. D.C. Medicaid paid the Health Advocacy Center in excess of $2.5 million for
manual therapy services that were not provided to the patients. The payments were deposited in bank
accounts controlled by Wheeler.
For further information contact Special Assistant U.S. Attorney Dangkhoa Nguyen (202) 7278008.
CASES
Counselors: Texas
Attorney General Greg Abbott announced on August 15 that licensed professional counselor
(LPC) James Edward Williams, was indicted by a state grand jury for Medicaid fraud and theft.
Williams, owner of Metropolitan Center for Counseling and Psychotherapy in Fort Worth, Texas,
allegedly billed Medicaid for services not rendered, which included billing for services provided by
unlicensed personnel.
For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker
(512)-371-4700.
Dentists: New York
Attorney General Eric T. Schneiderman announced on August 13 that Lawrence J. Bruckner
pleaded guilty to failing to pay taxes on payments he received from other dentists who worked at his
clinics. Bruckner will pay nearly $700,000 in restitution and will receive a multi-year prison sentence as
a result. Bruckner will pay restitution of $559,424 to the Medicaid Program and $121,912 to the New
2
Medicaid Fraud Report
July/August 2012
York State Department of Taxation and Finance prior to sentencing. Bruckner has agreed to be
sentenced to a period of one to three years in state prison. He and his business also face a
mandatory minimum five-year suspension from participation in the Medicaid and Medicare
programs.
From 2007 to 2011, Bruckner, Premier Dental, and three other dentists were paid
approximately $6.3 million by New York State’s Medicaid program for dental services allegedly
performed at Bruckner’s offices. Following the pleas, the Attorney General’s and Comptroller’s
offices will continue to investigate violations of the New York State False Claims Act by Bruckner and
his co-conspirators and may seek civil monetary recoveries from all of these dentists.
Under the False Claims Act, violators can be forced to pay up to three times the amount of
the loss to the Medicaid program and up to $12,000 per false claim.
Criminal investigations of the other dentists who worked at Bruckner’s offices are ongoing
and more arrests are possible.
For further information contact Special Assistant Attorney Generals Laura J. Meehan or
Christopher Y. Miller (212) 417-5261.
Dentists: Texas
Attorney General Abbott announced on August 15 that Michael D. Goodwin, DDS, was
indicted by a federal grand jury on 11 counts of health care fraud. Dr. Goodwin allegedly billed for
services provided by dental assistants who were practicing dentistry without a dental license while
he was out of state and no other dentist was on the premises. Dr. Goodwin also owns and operates
a dental practice in Indiana. The Medicaid overpayment is over $1.9 million.
For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker
(512) 371-4700.
Drug Diversion: New York
Attorney General Schneiderman announced on August 15 that five arrests were made in a
major narcotics trafficking scheme on Staten Island. An investigation revealed that Michael A.
Mancusi supplied his drug-dealing operation by allegedly fraudulently claiming serious and
permanent injuries related to motor vehicle accidents, and then applying for Social Security
Disability Insurance, Medicaid and Medicare benefits to unlawfully obtain prescription drugs,
including oxycodone, alprazolam (commonly known as Xanax and fentanyl patches. Together with
his girlfriend, co-defendant Shannon Daniell, and other co-conspirators, the Mancusi Organization
then illegally sold the drugs to buyers throughout New York City and Long Island.
3
Medicaid Fraud Report
July/August 2012
The felony complaint charges Mancusi with operating as a major trafficker; criminal
possession of a controlled substance in the first degree; criminal possession of a controlled
substance in the second degree; criminal sale of a controlled substance in the second degree;
attempted criminal sale of a controlled substance in the second degree; insurance fraud in the
second degree; grand larceny in the second degree; grand larceny in the third degree; scheme to
defraud in the first degree; conspiracy in the fourth degree; and criminal diversion of prescription
medication and prescriptions in the fourth degree, among other crimes. Daniell is charged with
criminal possession of a controlled substance in the first degree; criminal possession of a controlled
substance in the second degree; criminal sale of a controlled substance in the second degree;
attempted criminal sale of a controlled substance in the second degree; conspiracy in the fourth
degree, and criminal diversion of prescription medications and prescriptions in the fourth degree.
In separate felony complaints three additional defendants were charged. Defendant
Daniell’s mother, defendant Nancy Rivera-Daniell, is charged with attempted criminal sale of a
controlled substance in the fifth degree, conspiracy in the fifth degree and attempted criminal
diversion of prescription medication in the fourth degree. Ryan Leuchau is charged with criminal
possession of a controlled substance in the second degree, attempted criminal possession of a
controlled substance in the third degree and conspiracy in the fourth degree, among other charges.
Alixandra Bujka is charged with criminal possession of a controlled substance in the seventh degree
and conspiracy in the fifth degree.
If convicted, Mancusi and Daniell each face a maximum sentence of 20 years in prison.
Leuchau faces a maximum sentence of nine years in prison, and Rivera-Daniell faces a maximum
sentence of one and a half years in prison.
For further information contact Special Deputy Attorney General Monica Hickey-Martin
(212) 417-5261.
Drug Diversion: Texas
Attorney General Abbott announced on July 16 that Therese Marie D’Olivera entered a oneyear pre-trial diversion agreement. D’Olivera was indicted in December 2011 for obtaining a
controlled substance by fraud.
While employed by Hearne Healthcare Center, D’Olivera, a registered nurse allegedly
misappropriated morphine which had been prescribed to a facility resident.
****
Attorney General Abbott announced on July 19 that pharmacist Lisa Lyn Hollier, Dr. Nicolas
Padron, and Jose Lazaros Martinez, an employee of Dr. Padron, were indicted for conspiracy to
distribute controlled substances. Dr. Padron, through Padron Wellness Clinic and Martinez allegedly
distributed controlled substances via prescription without a legitimate medical purpose through
Hollier of Urban Independent Pharmacy.
4
Medicaid Fraud Report
July/August 2012
****
Attorney General Abbott announced on July 26, Carol Lynn Carr, a registered nurse was
indicted by a state grand jury for fraud and for fraudulent use of identifying information. Carr
allegedly obtained hydrocodone by fraud from a pharmacy in Athens while she was employed as an
RN at Renaissance Hospital in Terrell, Texas.
****
Attorney General Abbott announced on August 10, that licensed vocational nurse Nicole
Contreras accepted a 15-month pretrial diversion. She was indicted by a state grand jury in January
2012 for fraud. Contreras, while working at the Lubbock Health Care Center in Lubbock, Texas,
allegedly stole narcotics from the facility medication cart.
For further information about these cases contact Rick Copeland, Director or Chief
Investigator Travis Tucker (512)371-4700.
Durable Medical Equipment: Nevada
Attorney General Catherine Cortez Masto announced on July 3 that Marcia Giller was
sentenced for two felony offenses of submission of false Medicaid claims. The judge sentenced Giller
to consecutive terms of 18 to 48 months of imprisonment for each count, and additionally ordered
Giller to pay $226,000 in restitution, penalties and costs.
In December 2009, the Nevada Medicaid agency provided information to the Medicaid Fraud
Control Unit that AME Home Health Care (AME), a medical equipment company owned and
operated by Giller, had submitted and been paid Medicaid claims that were not supported by
required documentation.
A further investigation by the MFCU revealed that, in addition to the lack of supporting
documentation, Giller repeatedly submitted claims for persons who did not actually receive supplies
from AME. Giller nonetheless continued to submit fraudulent claims and receive payment over the
course of several years. Although Giller submitted claims under supposed client names and numbers,
those persons were unaware that their Medicaid information was being used in such a way. The
fraud occurred from January 2007 through May 2010.
For further information contact Senior Deputy Attorney General Matthew Jensen (775) 6841191.
Durable Medical Equipment: Ohio
Attorney General DeWine announced on August 7 that Willie Johnson was sentenced to five
years of community control, ordered to pay court costs in an amount to be determined, and ordered
to pay $137,920 in restitution.
5
Medicaid Fraud Report
July/August 2012
If Johnson violates community control he will receive a prison term of 17 months. Johnson
owned a transportation company and billed for ambulatory recipients and services not rendered.
For further information contact Assistant Attorney General William Greene (614) 466-0722.
Durable Medical Equipment: Texas
Attorney General Abbott announced on July 10 that Arthur Johnson pleaded guilty to theft
and was sentenced to ten years of probation, and ordered to pay restitution in the amount of
$165,888.
Arthur and Stephanie Johnson, co-owners of TOPS Medical Supply, were indicted in March
2011 for allegedly billing Medicaid for incontinence supplies that were not delivered. The identified
fraud is over $160,000.
****
Attorney General Abbott announced on July 11 that LaTonya Jones and Andtrica Shavelle
Howard pleaded guilty to theft with government contractor enhancements and were each given ten
years of deferred adjudication community supervision and ordered to jointly and severally pay
$31,000 in restitution.
Jones and Howard, owners and operators of Respiratory and Oxygen Plus, billed Medicaid
for incontinence supplies that were not delivered or only partially delivered.
****
Attorney General Abbott announced on July 20 that Joneshia Lashone Cranford pleaded
guilty in federal court to wrongful disclosure of individually identifiable health information.
Cranford sold Medicaid and Medicare recipient information to Shavator Shakum Albro and Francis
Joseph Ibiok. Albro used a closed DME company, Expediate Healthcare Supply, LLC to bill Medicaid
for incontinent supplies not provided. Albro and Ibiok allegedly entered into a kick-back scheme
with Victor Benson Ekpo to purchase protected healthcare information. Ekpo then allegedly billed
Medicaid and Medicare through Trak DME Corporation for orthotics that was never delivered.
Albro and Ibiok pleaded guilty to conspiracy to commit healthcare fraud and illegal
remuneration and are awaiting sentencing. Ekpo was indicted for conspiracy to commit healthcare
fraud and illegal remunerations and is awaiting trial. The Medicaid overpayment is over $221,000.
****
Attorney General Abbott announced on July 25 that Alex Shittu was indicted by a federal
grand jury for conspiracy to commit health care fraud, health care fraud, wire fraud, and aggravated
identity theft.
Shittu, owner of S & S Medical Supply, Etc. in Stafford, Texas, allegedly billed for incontinence
6
Medicaid Fraud Report
July/August 2012
supplies, ortho kits, and power wheelchairs that were not needed and/or not provided.
****
Attorney General Abbott announced on July 25 that Clifford Ubani and Princewill Njoku were
each sentenced in federal court to 87 months in prison with three years of supervised release.
Ubani and Njoku were also ordered to pay $566,451.12 in restitution to Medicare. Both previously
pleaded guilty to conspiracy to commit healthcare fraud. Njoku and Ubani, who owned Family
Healthcare Services in Houston, Texas, with their wives, were indicted with four others for their
roles in an alleged scheme to bill the accounts of Medicare beneficiaries for orthotic kits which they
did not receive.
****
Anna Quinteros and Rolandae Straughter pleaded guilty to conspiracy to commit health care
fraud. Quinteros was sentenced to three years of probation and ordered to pay $122,615.25 in
restitution to Medicare. Straughter was sentenced to 18 months in prison with three years of
supervised release and was ordered to pay $501,025.69 in restitution to Medicare. Michelle Turner
was convicted of conspiracy to commit health care fraud, conspiracy to receive kickbacks, and
receipt of kickbacks. Her sentencing is pending. Mary Lee Ellis was found not guilty at trial, but was
convicted in a related case. The identified overpayment is over $465,000.
****
Attorney General Abbott announced on August 1 that Sunday Adebisi was indicted by a
federal grand jury for conspiracy to commit health care fraud, health care fraud and aggravated
identity theft. Adebisi, owner of Ace Medical Supply and Accessories in Houston, Texas, allegedly
billed Medicaid and Medicare for medical equipment that was never properly prescribed by a
physician and sometimes never delivered to recipients. The Medicaid overpayment is approximately
$4,000, and the Medicare overpayment is approximately $855,000.
****
Attorney General Abbott announced on August 13 that Jose Trinidad Molina pleaded guilty in
state court to Medicaid fraud and fraudulent use of identifying information. Molina is the owner/
operator of Priority Care of America (PCA), a durable medical equipment company in San Antonio,
Texas. PCA allegedly billed Medicaid and Medicare for diabetic supplies that were not delivered, for
deceased clients, and for products that PCA did not purchase. The suspected Medicaid and Medicare
overpayments are over $840,000 and $41,000 respectively.
7
Medicaid Fraud Report
July/August 2012
****
Attorney General Abbott announced on August 16 that Shavator Shakun Albro was
sentenced in federal court to 180 days of home confinement, 15 weekends in jail, 60 months of
probation, and was ordered to pay $221,817.68 in forfeiture and restitution.
Albro pleaded guilty in August 2011 to conspiracy to commit healthcare fraud and illegal
remuneration. Albro allegedly used a closed DME company, Expediate Healthcare Supply, LLC, in
Lufkin, Texas, to bill Medicaid for incontinent supplies not provided. Albro and Francis Joseph Ibiok
allegedly used recipient information supplied by Joneshia Lashone Cranford while Cranford worked
as a licensed vocational nurse. Ibiok and Cranford pleaded guilty in federal court and are awaiting
sentencing. The Medicaid overpayment is over $221,000.
****
Attorney General Abbott announced on August 30 that Prince Nnamadi Oji was sentenced
in federal court to 57 months of incarceration and was ordered to pay $576,557.44 in restitution.
Oji will be deported upon completion of his sentence. Oji, owner of Florida Boulevard Medical
Supply in Lake Charles, Louisiana, pleaded guilty in January 2012 to money laundering.
He allegedly bought and sold many of the patient files identified in a related investigation of
Matrix Medical Equipment & Supply in Weirton, West Virginia. Matrix owner Jasper Amadi
Ogbonna was involved in a scheme to bill for durable medical equipment that was allegedly never
properly prescribed by a physician. Matrix was paid approximately $845,000 by Medicare but all
Medicaid claims were denied. Of the ten co-conspirators in the case, nine have been convicted
and sentenced; one remains a fugitive.
For further information about these cases contact Rick Copeland, Director or Chief
Investigator Travis Tucker (512) 371-4700.
Home Health Care: Ohio
Attorney General DeWine announced on July 16 that Paula Langhorn pleaded guilty to one
count of theft by deception, a misdemeanor of the first degree, and was sentenced to a 180 day
suspended jail sentence, two years’ probation, and ordered to pay restitution in the amount of
$6,000.
On February 21, an indictment was filed charging Langhorn with one count of complicity to
commit theft by deception, a felony of the fourth degree. Langhorn, a Medicaid recipient was
involved in kickback scheme with her provider.
For further information contact Assistant Attorney General Maritsa Flaherty (614) 4660722.
8
Medicaid Fraud Report
July/August 2012
****
Attorney General DeWine announced on July 19 that Rebecca Green pleaded guilty to
three counts of theft in office, felonies of the third degree, and two counts of tampering with
records.
Green was sentenced to four years in prison, three years of adult parole, and ordered to
pay restitution in the amount of $146,300.25.
On April 13, an indictment was filed charging Green with six counts of theft in office, all
felonies of the third degree, eight counts of theft, all felonies of the fourth degree, and five counts
of tampering with records, all felonies of the third degree. Green was a supervisor with the
Warren County Department of Human Services and falsified, altered, or destroyed governmental
paper and computer records to accomplish theft of benefits.
For further information contact Assistant Attorney General Nathan Smith (614) 466-0722.
****
Attorney General DeWine announced on August 1, Jade Mihelarakis pleaded guilty to one
count of Theft, a felony of the fifth degree and was sentenced to five years of community control,
ordered to pay court costs in the amount of $116, and ordered to pay $22,984.56 in restitution.
If Mihelarakis violates community control she will receive a ten month prison term. Mihelarakis,
an independent provider, billed for services not rendered.
****
Attorney General DeWine announced on August 20 that Megan McGuire pleaded guilty to
one count of falsification, a misdemeanor of the first degree, and was sentenced to a 30 day jail
term which will be suspended for full payment of $1,331.12 in restitution. McGuire, an
independent provider, billed for services not rendered.
****
Attorney General DeWine announced on August 29 that Shannon Jackson pleaded guilty to
one count of theft, a felony of the fifth degree, and was sentenced to five years of community
control, and ordered to pay $10,454.88 in restitution. Jackson, an independent provider, engaged
in a kickback scheme with the recipient to bill for services not rendered.
For further information about these cases contact Assistant Attorney General Jon Metzler
at (614) 466-0722.
9
Medicaid Fraud Report
July/August 2012
Home Health Care: Texas
Attorney General Abbott announced on July 26 that Jerry Ngozika Anyaehie pleaded guilty
in state court to aggravated theft. Anyaehie was the director for JEMAK Multi-Services Clinic, Inc., a
family and individual counseling clinic, and an owner/operator of Sunrise Clinic and Rehabilitation
Services, Inc., a chemical dependency therapy company, both in Houston, Texas.
JEMAK allegedly billed Medicaid for counseling that was not provided and sunrise allegedly
billed Medicaid for services not rendered for chemical dependency counseling of recipients who do
not have a chemical dependency. The overpayment to JEMAK and sunrise is over $383,000.
For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker
(512) 371-4700.
Home Health Care Agencies: Texas
Attorney General Abbott announced on August 30 that Roger Duane Blaker pleaded guilty in
state court to theft. Blaker is a former employee of Champion Care, Inc., a home health agency
based in Laredo, Texas, with offices in Corpus Christi, Texas. He was indicted for allegedly submitting
time sheets for recipients for whom services were never provided. The identified Medicaid
overpayment is approximately $44,000.
For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker
(512) 371-4700.
Home Health Care Aides: Ohio
Attorney General DeWine announced on July 3 that Jeremy Cunningham pleaded guilty to
one count of theft, a misdemeanor of the first degree, and was sentenced to a 120 day suspended
jail sentence, one year of probation, and ordered to pay restitution in the amount of $2,625.
On April 17, an indictment was filed charging Cunningham with one count of theft, a felony
of the fifth degree, and one count of falsification in a theft offense, a felony of the fifth degree.
Cunningham, an independent home health care aide, billed for services not rendered.
For further information contact Assistant Attorney General Constance Nearhood (614) 4660722.
****
Attorney General DeWine announced on July 6 that Marlon Watson pleaded to one count of
theft, a felony of the fourth degree and was sentenced to five years of community control, and
ordered to pay restitution in the amount of $35,000. If Watson violates community control he will
receive a 12 month prison sentence.
10
Medicaid Fraud Report
July/August 2012
On August 17, an indictment was filed charging Watson with one count of theft, a felony of
the fourth degree. Watson, an agency home health care aide, billed for services not rendered.
For further information contact Assistant Attorney General Benjamin Sigall (614) 466-0722.
****
Attorney General DeWine announced on July 18 that Nicole Douds pleaded guilty to one
count of theft, a felony of the fourth degree and was sentenced to five years of community control,
ordered to pay court costs in an amount to be determined, and ordered to pay restitution in the
amount of $35,000. If Douds violates community control she will receive a 12 month prison
sentence.
On January 24, an indictment was filed charging Douds with one count of theft, a felony of
the fourth degree, and one count of falsification in a theft offense, a felony of the fourth degree.
Douds, an independent home health aide, billed for services that she did not provide.
For further information contact Assistant Attorney General Constance Nearhood (614) 4660722.
****
Attorney General DeWine announced on July 26 that Jina Miller pleaded guilty to one count
of Medicaid Fraud, a felony of the fifth degree and was sentenced to five years of community
control, ordered to pay court costs in an amount to be determined, and ordered to pay restitution
in the amount of $15,000. If Miller violates community control she will receive a 12 month prison
sentence.
On September 20, an indictment was filed charging Miller with one count of theft, a felony
of the fourth degree, one count of forgery, a felony of the fifth degree, and one count of Medicaid
Fraud, a felony of the fifth degree. Miller, a home health aide, billed for services not rendered.
****
Attorney General DeWine announced on July 31 that Tracey Campbell pleaded guilty to one
count of theft, a misdemeanor of the first degree and was sentenced to a 30 day suspended jail
sentence, six months of community control, ordered to pay restitution in the amount of $939.36.
On May 15, an indictment was filed charging Campbell with one count of theft, a felony of
the fifth degree, one count of falsification in a theft offense, a felony of the fifth degree, and one
count of forgery, a felony of the fifth degree. Campbell, a home health aide, billed for services not
rendered.
11
Medicaid Fraud Report
July/August 2012
For further information on these cases contact Assistant Attorney General Jonathon
Metzler (614) 466-0722.
****
Attorney General DeWine announced on August 8 that Brandi Santiago pleaded guilty to
one count of theft by deception, a misdemeanor of the first degree, and was sentenced to a 180
day suspended jail term, five years of probation, ordered to pay court costs in an amount to be
determined, and ordered to pay $5,738.50 in restitution. Santiago, home health aide, billed for
services not rendered and was involved in a kickback scheme with a recipient.
****
Attorney General DeWine announced on August 8 that Charles Preston pleaded guilty to
one count of theft, a felony of the fifth degree and was sentenced to five years of community
control, ordered to pay court costs in an amount to be determined, and ordered to pay $3,000 in
restitution. If Preston violates community control he will receive a prison term of 11 months.
Preston was convicted of rape which makes him ineligible to be a home health aide.
Preston had his girlfriend; a home health aide, bill for services allegedly provided to his sister
Cynthia Preston and then split the money between Charles and Cynthia.
For further information on both cases contact Assistant Attorney General Maritsa Flaherty
(614) 466-0722.
****
Attorney General DeWine announced on August 20 that Chante Kerby pleaded guilty to
one count of attempted theft, a misdemeanor of the first degree, and was sentenced to a 180 day
suspended jail term, three years of probation, and ordered to pay $5,614.12 in restitution. Kerby,
a home health aide, billed for services not rendered.
****
Attorney General DeWine announced on August 22 that Kendra Lesley pleaded guilty to
one count of theft, a felony of the fifth degree, and was sentenced to three years of community
control, ordered to pay court costs in an amount to be determined, and was ordered to pay
$7,500 in restitution. If Lesley violates community control, she will receive a 12 month prison
term. Lesley, a home health aide, billed for services not rendered.
****
Attorney General DeWine announced on August 27 that LaTosha Martin pleaded guilty to
one count of theft, a misdemeanor of the first degree, and was sentenced to a 180 day suspended
jail term, four years of probation, and ordered to pay $2,039.32 in restitution.
12
Medicaid Fraud Report
July/August 2012
Martin, a home health aide, billed for services not rendered.
For further information on these cases contact Assistant Attorney General Daniel Huston
(614) 466-0722
****
Attorney General DeWine announced on August 30 that Brenda Senter pleaded guilty to
one count of theft by deception, a felony of the fifth degree, and was sentenced to three years of
community control, and ordered to pay $2,500 in restitution. If Senter violates community
control she will receive a six month prison term. Senter, a Medicaid recipient, made false
allegations of fraud against her home health aides when they refused to assist Senter in
committing Medicaid fraud.
For further information contact Assistant Attorney General Maritsa Flaherty (614) 4660722.
Medical Transportation: Ohio
Attorney General DeWine announced on July 12 that Paulette Lee pleaded guilty to one
count of theft, a felony of the fourth degree and was sentenced to three years of community
control, ordered to pay court costs in an amount to be determined, and ordered to pay restitution
in the amount of $10,000. If Lee violates community control she will receive an 11 month prison
sentence.
On September 20, an indictment was filed charging Lee with one count of theft, a felony of
the fourth degree. Lee, an independent provider, billed for services not rendered.
For further information contact Assistant Attorney General William Greene (614) 4660722.
****
Attorney General DeWine announced on August 2 that Delmarr Calhoun was sentenced to
six months of house arrest, two years of probation, ordered to pay a $100 special assessment, and
ordered to pay $143,070 in restitution. Calhoun, owner of DOC Transportation, billed for
ambulatory recipients.
For further information contact Assistant Attorney General Constance Nearhood (614) 466
-0722.
Mental Health Centers: Texas
Attorney General Abbott announced on July 24, that Shokoufeh Coste Hakimi, Sharonda
Denise Holmes, Shawn Eric Manney, Adam William Main and, Terry Wade Moore were indicted
for conspiracy to commit health care fraud, health care fraud and health care kickback violations.
13
Medicaid Fraud Report
July/August 2012
They were employees of Spectrum Care PA, a community mental health center. Spectrum owners
Cyrus Sajadi, MD, and Mansour Sanjar, MD, and employee Chandra Nunn, were indicted in
December 2011, also for conspiracy to commit health care fraud, health care fraud and health care
kickback.
Spectrum allegedly billed for services not rendered and paid kickbacks to ambulance
companies and individuals who supply patients. Hakimi, Spectrum's office manager, allegedly paid
kickback payments to ambulance companies and individuals who supplied patients. Holmes,
Manney and Nunn, recruiters for Spectrum, allegedly received kickback payments from Hakimi.
Main, a physician assistant, and Moore, a licensed clinical social worker, allegedly were involved in
the billing for services not rendered along with Drs. Sajadi and Sanjar.
For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker
(512) 371-4700.
Nurses: Colorado
Attorney General John Suthers announced on August 13 that Aracely Rodriguez pleaded
guilty and was sentenced for one count of criminal possession of an identification document, a class
6 felony, and one count of Nurse Aide-Unauthorized Practice, a class 2 misdemeanor. The judge
sentenced Rodriguez to two years of supervised probation, 48 hours of useful public service, $1,250
in fines, and no jail time. Rodriguez is to report her convictions to the Department of Regulatory
agencies (DORA), and pay court cost fees.
An investigation confirmed that Rodriguez used a false Social Security number and a false
certified nurse aide license to obtain employment in a skilled nursing facility.
For further information contact Assistant Attorney General Richard Ferro (303) 866-5284 or
Criminal Investigator Eric Gutzait (303) 866-5859.
****
Attorney General Suthers announced on August 31 that Vernita Jones pleaded guilty to and
was sentenced for one count of felony forgery, and one count of theft, $500 or over but less than
$1,000, a first degree misdemeanor. Jones was sentenced on a split plea. On the count of forgery,
Jones received a deferred judgment with two years of supervised probation and court costs.
On the count of theft, Jones received two years of supervised probation, 48 hours of useful
public service, no fines, restitution in the amount of $5,225.90, and court costs. As an additional
term of probation, she will report her convictions to the Department of Regulatory Agencies
(DORA).
Jones, a registered nurse, billed for services that she did not provide while she worked at a
different facility.
14
Medicaid Fraud Report
July/August 2012
For further information on both cases contact Assistant Attorney General Richard Ferro
(303) 866-5284 or Civil and Criminal Investigator Terry Miles (303) 866-4069.
Nurses: Ohio
Attorney General DeWine announced on August 20 that Yolanda Ruffin pleaded guilty to
one count of unauthorized use of property, a Misdemeanor of the first degree, and was
sentenced to six months of jail time, and ordered to pay $1,391.82 in restitution. The jail time is
to be suspended contingent upon payment of restitution by September 30, 2013, and provided
no new convictions for two years. Ruffin, a registered nurse billed for services not rendered.
For further information contact Assistant Attorney General Constance Nearhood (614)
466-0722.
Nursing Homes: Texas
Attorney General Abbott announced on August 23 that Peter Alan Kemp and Joanna Ellis
Kemp were sentenced in federal court to five years of probation, and each was fined $10,000 and
ordered to complete 100 hours of community service. The Kemps, owners of New Horizons
General Partnership in Dallas, Texas, operated three ICF/MR residential homes in Hood County,
Texas. They allegedly increased the costs reported as direct care wages and benefits on their
annual cost reports by using ghost employees, and allegedly billed Medicaid for services that
were not provided. The identified fraud is over $1.76 million.
For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker
(512) 371-4700.
Ophthalmologists: Texas
Attorney General Abbott announced on July 24 that Samuel Pierce, MD, pleaded guilty in
federal court to an information charging him with health care fraud. Dr. Pierce paid $174,855.75
in restitution as part of a plea agreement. This case involves Medicaid and Medicare patients
being seen for ophthalmology service at four satellite offices by opticians and billing for office
visits by a physician. Over $174,000 in overpayments has been identified.
For further information on both cases contact Rick Copeland, Director or Chief
Investigator Travis Tucker (512) 371-4700
Patient Trust Funds: Texas
Attorney General Abbott announced on July 27 that Melissa Carol Adler pleaded guilty in
state court to securing execution of a document by deception.
15
Medicaid Fraud Report
July/August 2012
Adler, while employed at Woodland Springs Nursing Center in Waco, Texas, allegedly orchestrated
the execution of a resident's will by deception, resulting in Adler receiving more than $169,000 from
the estate. Adler was allegedly assisted by attorney Raymond Eugene Rushing, the appointed
federal fiduciary overseeing the victim's estate. Rushing entered into a pre-trial diversion
agreement with special conditions on April 16, 2012.
****
Attorney General Abbott announced on August 2 that laundry supervisor Shirley Ann Conley
was indicted by a state grand jury for exploitation of an elderly individual. Conley allegedly asked
an elderly resident of Senior Rehabilitation and Skilled Nursing Center of Port Arthur, Texas, to loan
her money. Conley allegedly wrote checks on the residents’ personal checking account and signed
the resident's name to the checks.
****
Attorney General Abbott announced on August 2 that Alliance Home Healthcare Services coowner Edith Amadi was sentenced in federal court to 37 months imprisonment with two years of
supervised release, and was ordered to pay $853,702.62 in restitution. She pled guilty in December
2011 to conspiracy to commit healthcare fraud. Amadi was indicted with co-owners Ernest Amadi.
Agatha Opurum and George Opurum, and employee Ollie Futrell pleaded guilty for billing
Medicaid and Medicare for unnecessary services. All have pled guilty to conspiracy to commit
healthcare fraud. Futrell was sentenced to 33 months in prison.
For further information on these cases contact Rick Copeland, Director or Chief Investigator
Travis Tucker at (512) 371-4700.
Physical Therapists: Texas
Attorney General Abbott announced on August 6, that Nnonso Tony Obi pleaded guilty in
federal court to conspiracy to commit health care fraud and to money laundering. Sentencing is
pending. Obi was a marketer for City Nursing Services of Texas in Houston, Texas. City Nursing,
owned and operated by Umawa Imo, billed Medicaid and Medicare for physical therapy services
which were allegedly not needed and not provided. Obi and nine others were indicted for
conspiracy, health care fraud, kickback violations, and money laundering for their roles.
Four subjects have been sentenced to date, resulting in a combined prison time of 659
months and court ordered restitution of over $89 million. Between May 2007 to June 2009, Imo was
paid more than $30 million by Medicaid and Medicare.
For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker
(512) 271-4700.
16
Medicaid Fraud Report
July/August 2012
Physicians: Texas
Attorney General Abbott announced on July 25, that Alicia Vasquez was sentenced in federal
court to 12 months of incarceration, two years of probation, and was ordered to pay a $3,000 fine.
Vasquez, a marketer, pled guilty to charges that she was paid by a physician for referring patients.
The doctor allegedly took kickbacks for referrals to various DMEs and home health agencies.
****
Attorney General Abbott announced on August 15, that Emmanuel Nwora, MD, and Charles
Harris were indicted by a federal grand jury for conspiracy and health care fraud.
Dr. Nwora allegedly billed for vestibular testing that was not needed or provided. Harris
allegedly provided Dr. Nwora with the recipient information for the billing in return for a percentage
of the reimbursement. The investigation is a joint effort with HHS-OIG, FBI, and the MFCU.
****
Attorney General Abbott announced on August 29, that Rolando C. Vergel De Dios received
one year of deferred adjudication community supervision, was ordered to perform 40 hours of
community service, and pay a $500 fine after pleading guilty in state court to violating the medical
practice act. Vergel De Dios allegedly impersonated a medical doctor for over a year and treated
patients, admitted patients to a local hospital and wrote prescriptions for Schedule II and Schedule
III narcotics while employed by Manuel Soriano Rivero, MD. Rivero died of natural causes in
February 2011.
For further information on these cases contact Rick Copeland, Director or Chief Investigator
Travis Tucker (512) 371-4700
Podiatrists: Texas
Attorney General Abbott announced on August 21 that Bhavesh J. Shah, DPM, and Andrea C.
Iturrieta, a medical biller, were charged in an information with two counts of health care fraud.
Dr. Shah, owner of South Texas Foot Institute in San Antonio, Texas, and Iturrieta allegedly
submitted false claims for CPT codes and for more units of diabetic inserts than were furnished to
patients. The fraud is more than $83,000.
For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker
(512) 371-4700.
17
Medicaid Fraud Report
July/August 2012
Resident Abuse: South Dakota
Attorney General Marty Jackley announced on August 29 that Marshall Dillon Lee Peterson
was sentenced to 14 days in jail for assaulting a disabled child. In addition to the 14 days in jail, the
judge suspended the imposition of sentence, and placed Peterson on probation for three years.
Charges stemmed from an incident of simple assault that occurred while Peterson was employed at
a healthcare facility in Sioux Falls.
For further information contact Assistant Attorney General Paul Cremer at (605) 773-3215
Resident Abuse: Texas
Attorney General Abbott announced on June 27, that Wilma Jean Columb was sentenced to
eight years of probation, ordered to pay a $5000 fine, and write a letter of apology after pleading
guilty in state court to injury to a disabled individual. Columb, while employed with Bacon
Community Home in Abilene, Texas, allegedly abused a disabled resident by hitting him in the head
with a radio cord.
****
Attorney General Abbott announced on August 28, that Francis Uzoh pleaded guilty in state
court to injury to a disabled individual. Uzoh, former assistant manager of Gentle Hands Home Care
group home in San Antonio, Texas, was indicted in February 2010 for injury to a disabled individual.
An employee of Gentle Hands witnessed Uzoh allegedly assaulting a client, resulting in a broken
arm. This case is being prosecuted by the Bexar County District Attorney's Office.
For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker at
512-371-4700.
Social Workers: Texas
Attorney General Abbott announced on August 6 that Andrew Staffier was given five years
of deferred adjudication community supervision and was ordered to pay $15,271.19 in restitution.
He pleaded no contest in June 2012 to Medicaid fraud. Staffier, a clinical licensed social worker and
owner of Endeaver Health and Wellness, LLC, allegedly billed for case management services that
were not provided to clients.
For further information contact Rick Copeland, Director or Chief Investigator Travis Tucker
at (512) 371-4700.
18
Medicaid Fraud Report
July/August 2012
CASE UPDATES
Physicians
Attorney General Abbott announced on July 17 that Cal Wade Graves pleaded guilty in
federal court to conspiracy to commit healthcare fraud.
Graves and Daniel Leong, MD, South Dallas Community Medical Center, were indicted in
August 2011 for conspiracy to commit healthcare fraud. Dr. Leong allegedly billed for services not
rendered and allowed physician’s assistant Graves to prescribe controlled substances without a
medical need. (See: Medicaid Fraud Report, July/August 2011, p. 18). The alleged Medicaid fraud
identified is over $321,000.
****
Attorney General Abbott announced on July 23 that Shayna Lee, MD, pleaded guilty in state
court to engaging in organized criminal activity and was sentenced to ten years of deferred
adjudication community supervision, ordered to perform 240 hours of community service and, to
pay $70,000 in restitution. Lee, Eric Copeland, Mark Brown, Sherry James, Kevin Johnson, and
Chaketa Williams were indicted in March 2011 for allegedly billing Medicaid and Medicare for
psychological counseling and physical therapy services that were not provided.
Brown and Copeland were sentenced to four years of incarceration after pleading guilty to
theft. James received ten years of deferred adjudication community supervision and was ordered
to pay $48,800 in restitution after pleading guilty to engaging in organized crime. Johnson was
sentenced to four years of incarceration and was ordered to pay $25,000 in restitution after
pleading guilty to theft. (See: Medicaid Fraud Report, March/April 2011, p. 24).The fraud is
approximately $4.3 million.
****
Attorney General Abbott announced on August 15, that Robert Baker pleaded guilty in
federal court to conspiracy to violate anti-kickback statutes. Baker was a marketer allegedly paid to
bring patients to Adom Rehabilitation and Physical Medicine in Houston, Texas. Tina Collins, MD,
owner and operator of Adom, and employees Melloneen Davis and Cassandra Tasby, allegedly
billed Medicaid for services that were not rendered and paid patients to attend her clinic and allow
their Medicaid and Medicare identification numbers to be billed. (See: Medicaid Fraud Report,
May/June 2011, p. 19).
Dr. Collins pleaded guilty to conspiracy to commit health care fraud and was sentenced in
May 2012 to 24 months of incarceration followed by two years of supervised release and was
ordered to pay $1,894,938 in restitution to Medicare and $258,893 to Medicaid. Tasby and Davis
pleaded guilty to conspiracy to commit health care fraud.
****
19
Medicaid Fraud Report
July/August 2012
They were each sentenced in May 2012 to 36 months of probation with four months of home
confinement and were ordered to jointly and severally pay $42,052.48 in restitution to Medicare
and $8,338.68 to Medicaid. The identified overpayment is over $1.3 million.
State Employees: Texas
Attorney General Abbott announced on July 25 that Veronica Zamora was sentenced in
federal court to four years of probation and was ordered to pay $53,878 in restitution. Zamora pled
guilty in February 2012 to theft of funds from a health care benefit program. (See: Medicaid Fraud
Report, July/August 2012, p. 17).
Angela Grado was sentenced on July 12, 2012, to five years of probation and ordered to pay
$ 30,377.37 in restitution for her role in defrauding the medical transportation program. Olivia
Cardenas, Michael Zamora, Ericka Rojas, and Priscilla Rojas were sentenced on July 10, 2012, for
their roles in the scheme. Cardenas, a former state employee, was sentenced to 15 months of
imprisonment and was ordered to pay $53,878 in restitution. Zamora was sentenced to 10 months
in prison, three years of supervised release, and was ordered to pay $53,878 in restitution. Ericka
Rojas and Priscilla Rojas were each sentenced to three years of probation and were ordered to pay
$53,878 each in restitution..
Veronica Zamora, along with seven former state employees and 11 others, were indicted for
health care fraud, theft or embezzlement in connection with health care, and false statements
related to health care matters.
The former state employees worked for the Medical Transportation Program call center in
San Antonio where they allegedly authorized advance payments to be issued to relatives or friends
for Medicaid recipients transportation to medical appointments. The appointments were allegedly
never scheduled. The fraud is approximately $200,000.
For further information contact Director Rick Copeland or Chief Investigator Travis Tucker
(512) 371-4700.
20
Medicaid Fraud Report
July/August 2012
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 20036
bzelner@naag.org
Rob McKenna
President
National Association
of
Attorneys General
Charles H. Hobgood
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 2013, National Association of Attorneys General
21
Medicaid Fraud Report
July/August 2012
INDEX OF CASES
COUNSELORS ....................................................................................................................... 2
DENTISTS
Lawerence J. Bruckner.............................................................................................................. 2
Michael D. Goodwin ................................................................................................................. 3
DRUG DIVERSION
Alixandra Bujka, Shannon Daniell, Nancy Rivera-Daniell, Ryan Leuchau,
Michael A. Mancusi ................................................................................................................. 3
Carol Lynn Carr ........................................................................................................................ 5
Nicole Contreras ....................................................................................................................... 5
Therese Marie D’Olivera .......................................................................................................... 4
Lisa Lyn Hollier, Jose Lazaros Martinez, Dr. Nicolas Padron ................................................. 4
DURABLE MEDICAL EQUIPMENT
Shavator Shakum Albro ............................................................................................................ 8
Sunday Adebisi ........................................................................................................................ 7
Joneshia Lashone Cranford ....................................................................................................... 6
Marcia Giller ............................................................................................................................. 5
Andtrica Shavelle Howard, Latonya Jones ............................................................................... 6
Aurthur Johnson, Stephanie Johnson ........................................................................................ 6
Willie Johnson .......................................................................................................................... 5
Jose Trinidad Molina ................................................................................................................ 7
Princewill Njoku, Clifford Ubani ............................................................................................. 7
Prince Nnamadi Oji................................................................................................................... 8
Alex Shittu ................................................................................................................................ 7
HOME HEALTH CARE
Jerry Ngozika Anyaehie .......................................................................................................... 10
Rebecca Green .......................................................................................................................... 9
Shannon Jackson ....................................................................................................................... 9
Paula Langhorn ......................................................................................................................... 8
Megan McGuire ........................................................................................................................ 9
Jade Mihelarakis ....................................................................................................................... 9
HOME HEALTH CARE AGENCIES................................................................................ 10
HOME HEALTH CARE AIDES
Tracey Campbell ..................................................................................................................... 11
Jeremy Cunningham ............................................................................................................... 10
Nicole Douds .......................................................................................................................... 11
Chante Kerby .......................................................................................................................... 12
Kendra Lesley ......................................................................................................................... 12
Latosha Martin ........................................................................................................................ 12
Jina Miller ............................................................................................................................... 11
Charles Preston ....................................................................................................................... 12
Brandi Santiago ....................................................................................................................... 12
22
Medicaid Fraud Report
July/August 2012
INDEX OF CASES
Brenda Sentar .......................................................................................................................... 13
Marlon Watson........................................................................................................................ 10
MEDICAL TRANSPORTATION
Delmarr Calhoun ..................................................................................................................... 13
Paulette Lee ............................................................................................................................. 13
MENTAL HEALTH CENTERS ......................................................................................... 13
NURSES
Vernita Jones ........................................................................................................................... 14
Aracely Rodriguez .................................................................................................................. 14
Yolanda Ruffin........................................................................................................................ 15
NURSING HOMES .............................................................................................................. 15
OPTHALMOLOGISTS ....................................................................................................... 15
PATIENT TRUST FUNDS
Melissa Carol Adler ................................................................................................................ 15
Edith Amadi ............................................................................................................................ 16
Shirley Ann Conley................................................................................................................. 16
PHYSICAL THERAPISTS.................................................................................................. 16
PHYSICIANS
Rolando C. Vergel De Dios .................................................................................................... 17
Charles Harris, Emmanuel Nwora .......................................................................................... 17
Alicia Vasquez ........................................................................................................................ 17
PODIATRISTS ..................................................................................................................... 17
RESIDENT ABUSE
Wilma Jean Columb ................................................................................................................ 18
Marshall Dillon Lee Peterson ................................................................................................. 18
Francis Uzoh ........................................................................................................................... 18
SOCIAL WORKERS ........................................................................................................... 18
23