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					                                            MEDICAID FRAUD
                                               REPORT
National Association
of Medicaid Fraud Control Units                                                     January/February 2011


 INSIDE

Managed Care Administrator Pays
$2 Million to Kentucky Medicaid Program .......... 1
Cases ......................................................................... 2
Case Updates ........................................................... 23



         Managed Care Administrator Pays $2 Million to Kentucky Medicaid Program


       Attorney General Jack Conway announced on January 26 that AmeriHealth Mercy
Health Plan (AMHP), the Third Party Administrator for the Passport Health Plan, has agreed to
pay $2,032,758 in damages to the Kentucky Medicaid Program. Passport is the state’s
Medicaid managed care plan that serves Medicaid recipients in a 16-county area in and around
Louisville.

        The MFCU’s nine-month investigation centered on an allegation that AMHP falsely
reported its Health Effectiveness Data and Information Set (HEDIS) score for the cervical
cancer screening (CCS) measure to the Department of Medicaid Services in 2009. HEDIS
scores measure the performance of health care plans in specified areas such as how many
Medicaid recipients received cervical cancer screens. HEDIS scores are a ratio of plan
members in an eligible population who receive a service. For Cervical Cancer Screening, the
score is measured by determining how many eligible females received a Pap smear. Members
may also be excluded if they received a full hysterectomy.

        In 2009, AMHP was under contract with University Health Care, Inc. (UHC) to manage
the Passport Health Plan. The contract provided for a bonus payment to AMHP if it achieved
certain goals. If AMHP achieved a higher Cervical Cancer Screening score, it received more
than $677,000 in bonus money from UHC.

       The Commonwealth alleged that for the 2009 CCS HEDIS measure, AMHP excluded
members as having a full hysterectomy where there was no medical evidence of a full
hysterectomy. This increased the HEDIS score. AMHP also counted members as having
received a Pap smear where there was no medical evidence of a Pap smear. This also increased
Medicaid Fraud Report                                                               January/February 2011



   the HEDIS score. Together, these acts enabled AMHP to meet its goal and receive more than $677,000
   from UHC in Medicaid funds.

          The more than $2 million in the Judgment constitutes treble damages, or triple the amount of the
   actual damages, for the Kentucky Medicaid Program. In addition to the damages, the agreement
   requires that AMHP put procedures and personnel in place to ensure that all reports sent to both the
   Commonwealth and UHC, including HEDIS scores, are fully and completely accurate in the future.

           The MFCU was assisted by the U.S. Attorney’s Office for the Western District of Kentucky and
   the Department for Medicaid Services, UHC, which was not a party to the case. AMHP cooperated with
   this investigation.

          For further information contact Mitchel T. Denham, Director (502) 696-5405.

   CASES

   Dentists: Texas

          Attorney General Greg Abbott announced on January 21 that Kevin Oliver, DDS, was given 30
   days unsupervised deferred adjudication and was ordered to pay $38,120.46 in restitution, to surrender
   his dental license, and agree not to practice dentistry in Texas after pleading no contest in state court to
   criminal mischief. Dr. Oliver, a dentist, allegedly billed Medicaid for dental services that he did not
   provide.

                                                     ****

          Attorney General Abbott announced on January 24 that a dentist David Gonzales, Jr., a dentist,
   was sentenced in federal court to 12 months and one day incarceration, followed by three years
   supervised release and 100 hours of community service. He was ordered to pay $103,654 in restitution,
   and surrender his dental license. Gonzales was found guilty in August 2010 by a jury for health care
   fraud for billing Medicaid for services that were allegedly not provided. The suspected Medicaid
   overpayment is more than $166,000.

          For further information on both cases contact Rick Copeland, Director or Chief Investigator
   Travis Tucker (512) 371-4700.

   Drug Diversion: Texas

          Attorney General Abbott announced on December 8 that registered nurse (RN) Shirley Ann
   Risper was indicted by a state grand jury for possession of a controlled substance by deception. Risper,
   an employee of Treemont Health Care Center, allegedly diverted Norco tablets from a patient for her
   own use.




                                                       2
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                                                   ****

          Attorney General Abbott announced on December 9 that licensed vocational nurse (LVN)
   Pamela Taylor was indicted by a state grand jury for obtaining a controlled substance by fraud.
   Taylor, while employed with Levelland Nursing Home, allegedly documented giving patients Lortab
   when she had not.

                                                   ****

          Attorney General Abbott announced on January 11 that licensed vocational nurse Paul Zavala
   was given five years deferred adjudication community supervision, and was ordered for an MHMR
   evaluation and to perform 160 hours of community service after pleading guilty in state court to
   tampering with a governmental record and obtaining a controlled substance by fraud. Zavala, former
   employee of Trisun Care Center, allegedly diverted patient narcotics and gave them to his girlfriends.

          For further information on these cases contact Rick Copeland, Director or Chief Investigator
   Travis Tucker (512) 371-4700.

   Durable Medical Equipment: Texas

           Attorney General Abbott announced on November 10 that Archibong Edem- Effiong, Eme
   Edem Edet, and Roslyn Hadnot Woodard were indicted by a state grand jury for engaging in
   organized criminal activity. Despite being placed on Medicaid vendor hold in 2006 and 2007, owners
   of four DME companies, Effiong and Eme Edem Edet allegedly used different TPI numbers to start
   billing for incontinent supplies, the majority of which were never needed or provided. Woodard was
   identified by recipients as the marketer/recruiter who allegedly solicited them.

                                                   ****

          Attorney General Abbott announced on November 10 that Adeshola Oyenuga-Haastrup,
   owner/operator of Haastade Medical Supply, received ten years probation, was fined $2,000, and was
   ordered to pay $20,385.22 in restitution and forfeit her provider status after pleading guilty in state
   court to felony theft. Oyenuga-Haastrup was indicted in April 2010 for aggravated theft by a
   government contractor. Oyenuga-Haastrup allegedly billed Medicaid for incontinence supplies that
   were not delivered. The suspected Medicaid overpayments are approximately $18,800.

                                                   ****

            Attorney General Abbott announced on November 23 that Abiodun Durojaiye was sentenced
   in state court to ten years incarceration and was ordered to pay $1,500 in fines and $103,443.31 in
   restitution based on his guilty plea to aggregate theft by a government contractor. Durojaiye, doing
   business as Camad Medical Supplies, billed Medicaid for incontinent supplies and allegedly
   delivered lesser quantities of supplies or nothing at all. The investigation also revealed that Durojaiye
   had criminal convictions which he failed to disclose on his Medicaid provider enrollment application.



                                                      3
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                                                  ****

           Attorney General Abbott announced on November 29 that Linda E. Kendabie was sentenced
   in federal court to 15 months in prison followed by three years supervised release, and was ordered to
   pay $461,244 in restitution. Kendabie was the office assistant for Bassey M. Idiong, owner of B.I.
   Medical Supply, LLC. Kendabie, Idiong and recruiter Modupe A. Babanumi were indicted for an
   alleged scheme to bill ‘ortho’ kits which were not delivered and upcoding the billing on products that
   were provided. The estimated loss to Medicaid is approximately $413,000. Idiong pleaded guilty to
   healthcare fraud and conspiracy to commit healthcare fraud. Babanumi pleaded guilty to conspiracy
   to commit healthcare fraud and was sentenced to 366 days in prison with three years supervised
   release and was ordered to pay $92,754 in restitution.

                                                  ****

           Attorney General Abbott announced on November 30 that Callistus Edozie was sentenced in
   federal court to 41 months in prison with three years of supervised release, and was ordered to pay
   $80,000 in restitution. On November 29, 2010, DME owner Oliver Nkuku was sentenced in federal
   court to 120 months in prison with three years of supervised release, and was ordered to pay
   $453,112.10 in restitution. Nkuku, owner of KO Medical Supply, was found guilty in July 2010 of
   conspiracy to commit healthcare fraud. Edozie, a KO Medical Supply employee, pleaded guilty to
   conspiracy to commit healthcare fraud. Nkuku allegedly billed Medicaid and Medicare for ‘ortho
   kits’ and wheelchairs not delivered or provided products to recipients who did not qualify for the
   product.

                                                  ****

           Attorney General Abbott announced on December 10 that Shirley Roberts Chavis pleaded
   guilty in federal court to violating the anti-kickback statute. Chavis and Sunny Robinson were
   indicted for conspiracy to violate the anti-kickback statute, conspiracy to commit health care fraud,
   and health care fraud. Robinson, owner of Memorial Medical Supply, allegedly billed the accounts of
   Medicare and Medicaid beneficiaries for orthotic kits which they did not receive. In addition, some
   beneficiaries allegedly received cheap substitute neoprene braces and/or received total orthotic kits
   which were not medically necessary. Co-defendants Chavis, Lisa Dianne Jones and Manuel DeLuna
   allegedly received kickbacks from Robinson in exchange for providing beneficiary information.

         Jones pleaded guilty in August 2010 to conspiracy to violate the anti-kickback statute.
   DeLuna pleaded guilty in January 2010.

                                                  ****

           Attorney General Abbott announced on January 5 that Chimah Imoh was sentenced in federal
   court to five years of deferred adjudication, 120 days of home confinement, and was ordered to pay
   $56,421.78 to Medicare in restitution. Imoh was also excluded from participating in the health care
   industry. He pleaded guilty in July 2010 to conspiracy to commit wrongful disclosure of identifiable
   heath care information. Imoh, owner of Triple Star Medical Supplies, allegedly exchanged recipient
   information with other DME providers including Lodrick Chukwudi Eneh. Eneh was indicted on

                                                     4
Medicaid Fraud Report                                                            January/February 2011



   January 5 by a federal grand jury on three counts of conspiracy to commit health care fraud. All
   Medicaid crossover claims were denied.

                                                   ****

           Attorney General Abbott announced on January 12 that Howard Grant, MD, was sentenced to
   41 months of incarceration, followed by three years of supervised release and was ordered to pay
   $121,742.62 in restitution. Obisike S. Nwankwo was sentenced to 21 months of incarceration,
   followed by three years of supervised release and was ordered to pay $29,057.70 in restitution.
   Darnell Denese Willis was sentenced to 41 months of incarceration, followed by three years of
   supervised release and was ordered to pay $1,333,070.97 in restitution. Basil Obasi Kalu was
   sentenced in federal court to 70 months of incarceration, followed by three years of supervised release
   and was ordered to pay $1,046,922.68 in restitution. Michael Kalu Obasi was sentenced to 46 months
   of incarceration with three years supervised release and was ordered to pay $121,620.74 in restitution.
   Ju-Ying Qian was sentenced to five months of community confinement, followed by five months of
   home confinement and three years of probation and was ordered to pay $19,360.26 in restitution.
   Clinton Lee was sentenced to three years of probation. John Nasky Okonkwo pleaded guilty and will
   be sentenced later.

           All were involved in a fraud case centering on Onward Medical, a durable medical equipment
   company owned by Vinitski. Vinitski, through Onward Medical, billed Medicaid and Medicare for
   orthotic kits and wheelchairs that allegedly were not delivered or were provided to recipients who did
   not qualify for the product. The fraud scheme involved owner Vinitski using alleged fraudulent
   prescriptions by Dr. Grant, false billings by a clerk, and recruiting of recipients by the others.

                                                   ****

           Attorney General Abbott announced on January 14 that Margaret Holmes Tukes was
   sentenced in federal court to eight months home detention as part of five years supervised release, and
   was ordered to complete 400 hours of community service and pay $1,204,126 in restitution to
   Medicare and $100,207 to Medicaid. Tukes pleaded guilty to healthcare fraud in December 2008.
   Tukes, owner of M&M Medical Equipment, allegedly provided signed certificates of medical
   necessity to Adisa Fatai, owner of FAMS Medical Supply, in exchange for payment. Fatai was
   indicted for healthcare fraud and conspiracy and is a fugitive. Tukes and Fatai were paid for motorized
   wheelchairs and accessories while allegedly providing motorized scooters.

                                                   ****

          Attorney General Abbott announced on January 26 that Irma Cantu and Irma Linda Garcia
   were indicted by a state grand jury for theft. Cantu, owner of Moriah Medical Supplies, and biller
   Garcia allegedly billed Medicaid for services that were not rendered. In addition, both allegedly
   forged and photocopied patient signatures on invoices in order to bill Medicaid.

          For further information on these cases contact Rick Copeland, Director or Chief Investigator
   Travis Tucker (512) 371-4700.


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Medicaid Fraud Report                                                          January/February 2011




   Hearing Aids: Texas

           Attorney General Abbott announced on January 27 that Debra Spradlin pleaded guilty in
   federal court to conspiracy to commit healthcare fraud. Spradlin and her now deceased husband,
   Michael Wayne Spradlin, were indicted in August 2009 for healthcare fraud and aggravated identity
   theft. Michael Spradlin was a hearing aid fitter and distributor, doing business as Central Texas
   Hearing, a company co-owner and biller. The Spradlin's were paid for hearing aids and services that
   allegedly were not delivered. The suspected fraud is over $1.5 million.

                                                 ****

            Attorney General Abbott announced on January 28 that Mugeer Subhi Omar, owner of Nano
   Ear/Baylor Hearing, pleaded guilty in federal court to theft or embezzlement relating to health care
   fraud. Omar allegedly billed Medicaid for hearing aids that were not delivered and/or wanted by
   clients. The identified Medicaid overpayment is over $881,000.

          For further information on both cases contact Rick Copeland, Director or Chief Investigator
   Travis Tucker (512) 371-4700.

   Home Health Care: Nevada

           Attorney General Catherine Cortez Masto announced on December 15 that Steven Coward
   and Leslie Riggs pleaded guilty to a gross misdemeanor offense of intentional failure to maintain
   adequate records and were each sentenced for Medicaid fraud. District Court Judge Steven Elliot
   sentenced each to 12 months in jail, suspended, payment of $42,000 in restitution, penalties, and
   costs, and three years of probation. Coward was additionally sentenced to perform 80 hours of
   community service.

          The investigation began in 2007 after the MFCU obtained information that Coward was not
   providing personal care services to Riggs, who is his aunt and a Medicaid recipient. With Riggs’
   encouragement and assistance, Coward submitted claims to Medicaid and received payment as if he
   had actually provided services to Riggs.

          Medicaid has a personal care aid program to keep people living independently in their own
   homes by providing basic services, including bathing, dressing, house cleaning and meal preparation.
   Medicaid contracts with home care companies that in turn employ individuals to provide the actual
   day-to-day care. The investigation developed information that Coward indeed failed to provide care
   services for Riggs, that Riggs assisted Coward by asserting that services were provided to her by
   Coward and that Coward submitted claims through his employment agency and received payment of
   Medicaid funds as if he had actually performed the services.

          For further information contact Mark Kemberling, Director (702) 486-3111.




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Medicaid Fraud Report                                                              January/February 2011



    Home Health Care: Ohio

           Attorney General Mike DeWine announced on January 6 that Phyllis Bell was sentenced to
    five years of community control, 200 hours of community service, and ordered to pay court costs in
    an amount to be determined and restitution in the amount of $23,888.77. If the defendant violates
    community control, she will receive a ten month prison term.

            On July 20, 2010, an indictment was filed charging Bell with one count of theft, a felony of
    the fourth degree. On November 29, 2010, Bell pleaded guilty to one count of theft, a felony of the
    fifth degree. Bell, a home health care nurse, billed for services that were not rendered.

            For further information contact Assistant Attorney General Constance Nearhood (614) 466-
    0722.

                                                    ****

             Attorney General DeWine announced on December 6 that Christina Yates pleaded guilty to
    one count of theft by deception, a misdemeanor of the first degree and was sentenced to 30 days in
    jail, ordered to pay a $100 fine, court costs in an amount to be determined, and restitution in an
    amount of $3,099. Jail sentence is suspended provided defendant pays fine, court costs, and
    restitution in full by August 1, 2011.

           On February 16, 2010, an indictment was filed charging Yates with one count of theft by
    deception, a felony of the fifth degree, and two counts of forgery, felonies of the fifth degree. Yates,
    an LPN, billed for services not rendered.

            For further information contact Assistant Attorney General Shawn Napier (614) 466-0722.

    Home Health Care: Tennessee

            The Tennessee Medicaid Fraud Control Unit announced on December 8 that Keisha N
    Marcano, a nurse’s aide, pleaded guilty in court to one count of TennCare Fraud. Marcano received
    a post-plea diversion, was given six years probation, and ordered to pay $9,300 in restitution to the
    State of Tennessee. Additionally, Marcano has been referred to the abuse registry maintained by the
    Tennessee Department of Health.

            This case was opened on October 28, 2008 based upon a referral from the Division of Mental
    Retardation Services. It was alleged that Marcano, while simultaneously employed as companion
    staff for New Horizons and as direct care staff for Friendship Home Solutions, submitted timesheets
    for services performed on behalf of both agencies at the same time and in different locations.
    Marcano would perform services for one recipient and Marcano’s husband, who was not employed
    by either agency, would perform services for the other recipient during the conflicting shifts. An
    analysis of timesheets, billings, and daily notes was used to identify the overlapping shifts and
    quantify the amounts fraudulently billed to TennCare. Marcano was interviewed and admitted to the
    fraudulent practice of double-billing.

            For further information contact Special Agent Ramona Smith (615) 744-4229.
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Medicaid Fraud Report                                                           January/February 2011



    Home Health Care: Texas

            Attorney General Abbott announced on January 20 that Princewill Njoku and Clifford Ubani
    pleaded guilty in federal court to conspiracy to commit health care fraud, conspiracy to pay
    kickbacks, and payment of kickbacks. Ubani and Njoku, owners of Family HealthCare Services, and
    their respective wives, Ezinne and Caroline, allegedly orchestrated a scheme to pay home health
    nurses and marketers for the re-certification of home healthcare patients. The wives and two others
    were indicted in June 2010 for conspiracy to commit health care fraud. Eight others were indicted in
    October 2010 for their involvement with Family HealthCare and two of those have pled guilty.

                                                  ****

           Attorney General Abbott announced on January 28 that Eva Jo Hopson was sentenced in
    state court to seven years incarceration and was ordered to pay $41,149.50 in restitution after
    pleading guilty to theft and misapplication of fiduciary property. Hopson, former assistant director
    of Burnet County MR Board, allegedly diverted money from her former employer, a subcontractor
    of Bluebonnet Trails, by issuing herself false payroll and commission checks.

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

    Home Health Care: Vermont

           Attorney General William H. Sorrell announced on January 26 that Marja Lawrence pleaded
    guilty on January 25 in Superior Court to one felony count of Medicaid fraud. The conviction
    stemmed from Lawrence’s submission of fraudulent timesheets for payments in excess of $14,000
    for providing care under Vermont Medicaid’s Choices for Care program when, in fact, she provided
    no such care. The plea also includes an agreement to pay back the state for other funds unlawfully
    obtained through a false application to the Department of Children and Families childcare subsidy
    program.

            Lawrence was sentenced to four to seven years, all suspended except 90 days to be served on
    work crew, and placed her on five years probation, subject to standard conditions and three special
    conditions of probation. While on probation, special conditions will prohibit Lawrence from
    working in any position which would involve directly caring for, supervising care of, or close
    interaction with vulnerable adults and will prohibit her from overseeing other Medicaid care
    providers. The judge also ordered that Lawrence pay restitution of $17,612.28 to the state programs
    that were defrauded. As a result of the felony conviction, the HHS Office of the Inspector General
    is likely to exclude Lawrence from working in any Medicare- or Medicaid- funded facilities for up
    to five years.

           For further information contact Assistant Attorney General Micaela Tucker (802) 828-5341.

    Home Health Care: Ohio

           Attorney General DeWine announced on January 10 that Mark Geygen pleaded guilty to one
    count of theft, a misdemeanor of the first degree and was sentenced to three months in jail, and
                                                     8
Medicaid Fraud Report                                                              January/February 2011



    ordered to pay court costs and restitution in the amount of $4,499.53.

           On August 18, 2010, an indictment was filed charging Geygan with one count of theft, a
    felony of the fifth degree. Geygan, a home health care aide, billed for more services than he
    provided.

                                                   ****

             Attorney General DeWine announced on January 13 that Julie Mayle pleaded guilty to one
    count of theft, a misdemeanor of the first degree and was sentenced to 30 days in jail, eight months
    of probation, ordered to pay court costs in the amount of $151, and ordered to pay restitution in the
    amount of $848.88. The 30 day jail sentence is suspended if the defendant pays court costs and
    restitution by August 13.

           On September 21, 2010, an indictment was filed charging Mayle with one count of theft, a
    felony of the fifth degree. Mayle, a home health care aide, billed for more services than she
    provided.

          For further information on both cases contact Assistant Attorney General Constance
    Nearhood (614) 466-0722.

                                                   ****

           Attorney General DeWine announced on January 13 that Merranda Stacey was sentenced to
    five years of community control, 40 hours of community service, ordered to pay court costs in an
    amount to be determined, and ordered to pay restitution in the amount of $18,169.64. If the
    defendant violates community control, she will receive a prison term of 12 months.

           On April 20, 2010 an indictment was filed charging Stacey with one count of theft, a felony
    of the fourth degree. On November 23, 2010 Stacey pleaded guilty to one count of theft by
    deception, a felony of the fifth degree. Stacey, a home health care aide, billed for services that were
    not provided.

                                                   ****

           Attorney General DeWine announced on January 13 that Demarlah Perkins pleaded guilty
    to one count of theft, a misdemeanor of the first degree and was sentenced to six months in jail,
    ordered to pay court costs in an amount to be determined, and ordered to pay restitution in the
    amount of $927. Jail sentence is suspended if defendant pays court costs and restitution by August
    12.
           On April 20, 2010 an indictment was filed charging Perkins with one count of theft, a
    felony of the fifth degree. Perkins, a home health care aide, billed for services not rendered.

           For further information on both cases contact Assistant Attorney General William Greene
    (614) 466-0722.


                                                      9
Medicaid Fraud Report                                                            January/February 2011



                                                   ****

           Attorney General DeWine announced on January 27 that Fontanae Bozeman was sentenced to
   five years of probation, ordered to pay a fine of $250, pay court costs in an amount to be determined,
   and pay restitution in the amount of $16,500. If the defendant violates probation she will receive a
   prison term of 12 months.

            On April 20, 2010, an indictment was filed charging Bozeman with one count of theft by
   deception, a felony of the fourth degree. On October 18, 2010, Bozeman pleaded guilty to one count
   of theft by deception, a felony of the fifth degree. Bozeman, a home health care aide, allowed her non
   -certified daughter to provide services to her clients. She also billed for times when she was out of
   state.

           For further information contact Assistant Attorney General Shawn Napier (614) 466-0722.

                                                   ****

          Attorney General DeWine announced on January 28 that Imogene Collins pleaded guilty to
   one count of theft, a misdemeanor of the first degree and was sentenced to 180 days in jail, which
   were suspended, two years probation, and ordered to pay restitution in the amount of $1,181.50.

          On September 21, 2010 an indictment was filed charging Collins with one count of theft, a
   felony of the fifth degree. Collins turned in false time sheets for home health services causing the
   agency to bill for services that were not provided.

           For further information contact Assistant Attorney General Constance Nearhood (614) 466-
   0722.

   Home Health Care Aides: Oregon

           Attorney General John Kroger announced on January 25 that a woman received a 19 month
   prison sentence for stealing nearly $39,000 from the state Medicaid program, a significant sentence in
   a theft case.

          Michelle Alta Russell was sentenced in court to 19 months in prison after pleading guilty on
   January 18 to two counts of aggravated identity theft, one count of first degree theft and one count of
   making a false claim for health care payment. She was also ordered to pay $38,887 in restitution.

           Russell, a home care provider, quit working for a disabled elderly woman three years ago.
   The Oregon Department of Human Services mistakenly continued to send her pay vouchers, which
   the provider and recipient are both supposed to sign, indicating how many hours the provider worked
   for the recipient. The voucher is then submitted to DHS, which cuts a paycheck for the provider
   based on the number of hours worked. Russell forged the signature of the disabled elderly woman on
   the vouchers, claiming she had provided many hours of care for her, when she had in fact worked
   none. Russell’s partner, Nick Allan Cerkoney, helped with the fraud by depositing the ill-gotten gain
   into their joint credit union account.

                                                     10
Medicaid Fraud Report                                                            January/February 2011




          Cerkoney pleaded guilty January 18 to two counts of first degree theft and was sentenced to
   20 days in jail, two years probation during which time he is not to handle Medicaid funds and was
   ordered to pay $5,827 in restitution.

         For further information contact Senior Assistant Attorney General Elizabeth Ballard (971)
   673-1880.

   Hospitals: Georgia

           Attorney General Samuel S. Olens announced on February 8 that Georgia has reached a
   $2.717 million dollar civil settlement with St. Joseph’s/Candler Health System (SJCHS), relating to
   Medicaid billing for inpatient and outpatient services provided at two hospitals. This settlement
   follows a similar settlement for $2.738 million last fall reached with WellStar Health Systems and
   five hospitals.

          The settlement with SJCHS follows an ongoing investigation by the Georgia Medicaid Fraud
   Control Unit and the Department of Community Health (DCH), with assistance from an outside
   auditing firm under contract with DCH. The focus of the investigation is billing for Medicare “cross-
   over” claims to Medicaid as secondary insurance. Under Medicaid policies, reimbursement is paid
   according to a schedule of DRGs, or diagnostic related groups. The Medicaid DRG acts as a cap on
   the amount of reimbursement a hospital can receive. The investigation found that SJCHS filed claims
   which did not reflect the full amount of Medicare prior payments, allowing the hospitals to receive
   excessive Medicaid reimbursements.

           Under the terms of the agreement, SJCHS denied any wrongdoing, but agreed to pay the
   Georgia Department of Community Health a lump sum of $2,728,318 to settle all possible claims
   related to the incorrect billing. SJCHS also agreed to pay an additional $2,500 to defray the costs of
   its investigation. SJCHS cooperated with the state’s investigation, and implemented corrective
   actions to ensure that similar billing problems do not reoccur.

           For further information contact Senior Assistant Attorney General Scott Smeal (770) 414-
   3655.

   Medical Transportation: Ohio

           Attorney General DeWine announced on January 19 that Awad Hussan 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 restitution in the amount of $34,187.78. If the defendant violates community control,
   he will receive a prison term of six months.

            On December 21, 2010 a bill of information was filed charging Hassan with one count of
   theft, a felony of the fifth degree. Hassan, owner of Health Care Transportation, billed for wheelchair
   transports when the recipients were not transported in wheelchairs.



                                                     11
Medicaid Fraud Report                                                            January/February 2011


                                                   ****

           Attorney General DeWine announced on January 25 that Phillip Taylor was sentenced to
    one year and one day in prison, three years of supervised release, and ordered to pay restitution in
    the amount of $195,670.86.

            On April 14, 2010, an indictment was filed charging Taylor with one count of health care
    fraud and three counts of making a false statement in a health care matter. On September 7, 2010
    Taylor pleaded guilty to one count of making a false statement in a health care matter. Taylor, as
    manager of X-Press Transportation, billed for extra attendant services, when none was provided for
    nearly all transports.

          For further information on both cases contact Assistant Attorney General Constance
    Nearhood (614) 466-0722.

    Medical Transportation: Texas

            Attorney General Abbott announced on November 22 that Anthony Dwayne Wilkerson,
    operations manager of both MedFirst Ambulance Service and Citizen Care Ambulance, was
    sentenced to two years of probation and fined $1,500 for each of two ambulance cases in state court
    after pleading guilty to theft. Wilkerson and MedFirst and CareFirst company owners Michael
    Powell and Keith Powell were indicted in June 2010 for securing execution of document by
    deception. Wilkerson was also indicted for transporting patients who did not qualify for ambulance
    transport to their scheduled dialysis treatments.

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

    Nurses: Colorado

           Attorney General John Suthers announced on January 13 that Myra Martinez pleaded guilty
    to 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 remaining counts were dismissed.

            An investigation confirmed that Martinez used a false Social Security Number, a false
    Certified Nurse Aide License, and false government ID to obtain employment as a CNA in a skilled
    nursing facility.

            For further information contact Assistant Attorney General Richard Ferro or Criminal
    Investigator Theresa Bradbury (303) 866-5431.

                                                   ****

           Attorney General Suthers announced on January 24 that Nancy Engelhardt pleaded guilty to
    one count of identity theft, a fourth degree felony, one count of forgery, a fifth degree felony, and
    one count of criminal attempt to commit theft, a third degree misdemeanor. Engelhardt was
    sentenced concurrently to two years and one year with the Department of Corrections, and three

                                                     12
Medicaid Fraud Report                                                                January/February 2011


   months of jail, suspended, two years of reporting probation, 48 hours of useful public service; she was
   ordered to pay court costs in an amount to be determined, and to pay fines in the amount of $4,050. All
   remaining counts were dismissed.

           On October 12, 2010, a criminal information was filed charging Engelhardt with four counts of
   identity theft, all felonies of the fourth degree, four counts of forgery, all felonies of the fifth degree,
   and one count of criminal attempt to commit theft, a third degree misdemeanor.

          The convictions stemmed from Engelhardt’s, a registered nurse, submission of falsified medical
   records, timesheets, and billing statements in order to obtain payment from Medicaid for services that
   were not rendered.

                                                     ****

          Attorney General Suthers announced on January 24 that Heather Richardson pleaded guilty to
   one count of identity theft, a fourth degree felony, one count of forgery, a fifth degree felony, and the
   one count of criminal attempt to commit theft, a third degree misdemeanor. All remaining counts were
   dismissed.

           On October 12, 2010, a criminal information was filed charging Richardson with four counts of
   identity theft, all felonies of the fourth degree, four counts of forgery, all felonies of the fifth degree,
   and one count of criminal attempt to commit theft, a third degree misdemeanor.

          The convictions stemmed from Richardson’s, a registered nurse, submission of falsified
   medical records, timesheets, and billing statements in order to obtain payment from Medicaid for
   services that were not rendered.

         For further information on both cases contact Assistant Attorney General Richard Ferro or
   Criminal Investigator Anthony Matthews (303) 866-5431.

   Nurses: Ohio

          Attorney General DeWine announced on December 13 that Amy French pleaded guilty to one
   count of theft, a misdemeanor of the first degree and was sentenced to a 180 day suspended jail
   sentence, six months probation, and ordered to pay restitution in the amount of $679.80.

           On June 15, 2010 an indictment was filed charging French with one two counts of theft, both
   felonies of the fifth degree. French, an RN, who billed for services not rendered.

            For further information contact Principal Assistant Attorney General Jordan Finegold (614) 644
   -0722.

   Nurses: Texas

          Attorney General Abbott announced on December 8 that registered nurse Brenda Burmaster
   was indicted by a state grand jury on three counts of injury to the elderly by exploitation. Burmaster, an
   employee of the Arboretum Nursing and Rehabilitation Center in Winnie, allegedly used improper
   influence to convince at least three residents to loan her money.
                                                       13
Medicaid Fraud Report                                                            January/February 2011




                                                  ****

           Attorney General Abbott announced on December 10 that registered nurse Brandon Allen
   Ray was sentenced in federal court to 15 months of incarceration with three years supervised
   probation, and was ordered to pay $115,937 in restitution. Ray pleaded guilty in April 2010 to
   healthcare fraud, conspiracy and embezzlement. Ray was employed by Rosa's First Quality Home
   Healthcare. While there, he allegedly fraudulently billed Medicaid for the care of a comatose child at
   the rate of 16 hours per day, six days a week.

          For further information on both cases contact Rick Copeland, Director or Chief Investigator
   Travis Tucker (512) 371-4700.

   Nursing Homes: Alabama

         Attorney General Luther Strange announced on January 18 the arrest of a former nursing
   home bookkeeper for the theft of $115,734.61 from Wetumpka Health and Rehabilitation Nursing
   Home.

           Joseph James Feagin Jr. was arrested by agents of Attorney General Strange’s Medicaid
   Fraud Control Unit and the Elmore County Sheriff’s Department at his home on a warrant for first-
   degree theft of property, a class B felony which is punishable by two to 20 years imprisonment and a
   fine of up to $30,000. Feagin was transported to jail, where he is being held on a $30,000 bond.


          The case was investigated by Senior Special Agent Gerald Shockley and Special Agent
   Tracey Edwards of the Alabama Medicaid Fraud Unit after management at the nursing home reported
   the matter.

          For further information contact Bruce Lieberman, Director (334) 353-8793.

   Pharmacies: Georgia

            Attorney General Olens announced on December 15 that pharmacist J. Harris Morgan was
   sentenced to thirty months in confinement followed by three years of supervised release. Morgan
   was also ordered to pay $2,804,462 in restitution to the Georgia Department of Community Health.
   Morgan was found guilty on 69 counts of health care fraud in October of 2008 following a two-week
   jury trial.

           The indictment charged that for a period of several years ending in August 2007, Morgan, a
   registered pharmacist and the owner of Thrift Center Pharmacy, executed a scheme to defraud the
   Georgia Medicaid program by submitting false and fraudulent claims for Synagis and other
   drugs. Synagis is an injectable anti-body used to prevent RSV, a serious respiratory disease in
   premature infants and other high-risk children. Morgan repeatedly billed Medicaid for more Synagis
   than had actually been administered to the patient, and he billed Medicaid when no Synagis at all had
   been administered. Morgan also instructed his staff to use a false diagnosis which had not been given

                                                    14
Medicaid Fraud Report                                                             January/February 2011



   by the physician, in order to obtain approval from the Medicaid program to dispense Synagis to
   patients who would not otherwise have qualified to receive it.

           For further information contact Senior Assistant Attorney General Nancy Allstrom (770) 414-
   3655.

   Pharmacies: Texas

          Attorney General Abbott announced on January 14 the Office of the Attorney General was
   awarded $423,180.53 in a state judgment forfeiting seized funds from four bank accounts belonging
   to Marcellius Jhekwuoba Anunobi. Anunobi, president and pharmacist-in-charge of Advanced
   Doctor's Prescribed Pharmacy, was tried for Medicaid fraud, theft, and money laundering and
   sentenced to 20 years of incarceration and ordered to pay $2.2 million in restitution. Anunobi
   allegedly billed the Texas Vendor Drug Program for prescriptions that were never filled.

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

   Physicians: Ohio

           Attorney General DeWine announced on December 14 that Veronica Scott pleaded guilty to
   one count of making a false statement in a health care matter, and one count of health care fraud
   (both federal charges). Scott was sentenced to one year house arrest, 104 hours of community service,
   three years probation, and ordered to pay restitution in the amount of $65,896.65.

           On January 10, 2010, an indictment was filed in federal court charging Scott with 14 counts
   of making a false statement in a health care matter, one count of health care fraud, four counts of
   illegal distribution of drugs, and one count of illegal distribution with a prescription (all federal
   charges).

          Scott, an office manager, treated patients and issued prescriptions with the knowledge of co-
   defendant Charles Njoku, causing Medicaid to be billed for physician services. Scott has no medical
   education or training.

                                                   ****

         Attorney General DeWine announced on December 29 that Charles Njoku was sentenced to
   one year and one day in prison, one year of house arrest, three years of probation, 416 hours of
   community service, and ordered to pay restitution in the amount of $65,896.65.

           On June 29, 2010 an indictment was filed in federal court charging Njoku with 13 counts of
   making a false statement in a health care matter, one count of health care fraud, and four counts of
   illegal distribution of drugs (all federal charges). On September 28, 2010, Njoku pleaded guilty to
   one count of health care fraud, and one count of illegal distribution of drugs. Njoku, a medical doctor,
   billed for physician services provided by his office manager and co-defendant Scott, who had no
   medical degree and also provided Scott with pre-signed prescriptions for scheduled II controlled

                                                     15
Medicaid Fraud Report                                                             January/February 2011



   substances.
          For further information on both cases contact Assistant Attorney General Constance
   Nearhood (614) 466-0722.

                                                   ****

           Attorney General DeWine announced on January 31 that John Gholl pleaded guilty 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 $28,878.70 to be paid to Ohio Department of Job &
   Family Services, $52,387.08 to be paid to Care Course, $35,504.43 to be paid to Molina Healthcare
   of Ohio, and $51,310.74 to be paid to Unison Health Plans, Inc. If the defendant violates community
   control he will receive a prison term of 18 months.

          On December 21, 2010 a bill of information was filed charging Gholl with one count of theft,
   a felony of the fourth degree. Gholl, a medical doctor, was upcoding billing for office visits.

          For further information contact Assistant Attorney General William Greene (614) 466-0722.

   Physicians: Texas

           Attorney General Abbott announced on January 10 that Edward Alexander Birts was
   sentenced in federal court to 65 months of incarceration with three years of supervised release, and
   was ordered to pay $843,489.24 in restitution to Medicaid and $125,094.44 to Medicare. He pleaded
   guilty in June 2010 to healthcare fraud and identity theft. Birts, owner of Courage to Change, a
   physicians' group, billed Medicaid and Medicare for psychotherapy counseling and physical therapy.
   Birts allegedly listed either another doctor or himself as providing the counseling and therapy. The
   other doctor was unaware his provider number was used and Birts is not qualified to perform the
   services.

                                                   ****

           Attorney General Abbott announced on January 19 that Harold Wagner, DO, pleaded guilty
   in federal court to accepting kickbacks involving health care programs. Wagner was allegedly paid to
   authorize certificates of medical necessity that resulted in the purchase and Medicaid and Medicare
   payment for power wheelchairs.

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

   Resident Abuse: District of Columbia

          The District of Columbia Medicaid Fraud Control Unit announced on January 12 that Annette
   Holloman, a former employee of RCM of Washington, Inc. (RCM), a residential provider for persons
   with cognitive disabilities, was sentenced for criminal abuse and assaulting a vulnerable person in her
   care.


                                                     16
Medicaid Fraud Report                                                             January/February 2011




           Holloman was found guilty in October 2010 of two counts of criminal abuse of a vulnerable
   adult and two counts of assault after a trial. On January 10, Holloman was sentenced to 60 days in
   prison, with all but seven days suspended, and 12 months of supervised probation. Additionally, the
   court ordered her to pay $100 towards the Victims of Violent Crime Compensation Act fund.

          According to testimony at trial, on December 21, 2008, Holloman was caring for an adult
   with cognitive disabilities. Another caretaker in the facility witnessed Holloman hit the victim on the
   back of his head and neck with the buckle end of a belt. Holloman also hit the victim on the back of
   his hand and on his ribs with an exercise hand grip. Additionally, Holloman stomped on the victim’s
   foot while she was wearing hard-soled shoes.

          For further information contact Investigator Allen Johnson or Special Assistant U.S. Attorney
   Jacqueline N. Schesnol (202) 727-8008.

                                                   ****

           The District of Columbia Medicaid Fraud Control Unit announced on February 2 that James
   Brewster has been sentenced to five years of probation for an incident in which he assaulted a female
   client with cognitive disabilities at a day program where he worked as a maintenance employee.

          Brewster pleaded guilty in July 2010 in Superior Court to a charge of attempted first degree
   sexual abuse of a ward.

          The probation is to be supervised by the Sexual Offender Treatment Unit. Brewster will be
   required to undergo sexual offender evaluation and treatment if appropriate, as well as drug testing.
   He also must maintain verifiable employment, limit any contact with vulnerable adults, and stay
   away from the victim and the day program that she attends. He must pay $200 to the Victims of
   Violent Crime Compensation Act fund. In addition, Brewster is required to register as a sexual
   offender for a period of ten years.

          According to the government’s evidence, Brewster was a maintenance worker at a day
   program. The program served the victim and other adults who have cognitive disabilities. In June
   2009, Brewster made the victim perform sexual acts in a women’s rest room and prevented her from
   leaving by holding the door closed. The victim reported the assault to a staff member the next day.

         For further information contact Criminal Investigator Shante McGee or Susan Bieber
   Kennedy, Special Assistant U.S. Attorney and Director (202) 727-8008.

   Resident Abuse: Florida

          Attorney General Bill McCollum announced on November 9 the arrest of a personal care
   attendant formerly employed by Community Outreach. Amanda Capers was arrested for neglecting a
   disabled adult under her care and forging official documents.

          Based on information from the Florida Department of Children and Families Adult Protective

                                                     17
Medicaid Fraud Report                                                            January/February 2011




   Services Division, investigators discovered that Capers violated facility policy. While on duty,
   Capers took a resident with her to a friend’s house and permitted the disabled adult to ride on the
   back of a moped which collided with another moped. Due to the collision, the disabled man suffered
   a broken leg which required surgery.

           Following the accident, Capers falsified the initial incident report. Upon closer examination,
   investigators determined that Capers also falsified her driving record that she had submitted when
   applying for the position at Community Outreach. Capers’ driver license has been suspended since
   2007.

           Capers was charged with one count of neglect of a disabled adult causing great bodily harm, a
   second-degree felony, as well as one count of forgery and one count of uttering forged documents,
   both third-degree felonies. If convicted on all counts, Capers faces a maximum of 25 years in prison
   and $20,000 in fines.

         For further information contact David Lewis, Director or Regional Chief Betty Zachem (850)
   414-3600

   Resident Abuse: Massachusetts

          Attorney General Martha Coakley announced on February 2 that a district court jury has
   convicted a woman in connection with assaulting an elderly nursing home resident while she was
   working as a certified nursing assistant (CNA) assigned to the Hunt Nursing and Retirement Home.

          Nancy Aiguobargueghian was convicted of assault and battery on an elderly person. She was
   sentenced to serve two years of supervised probation with conditions that she complete an anger
   management course, and that she provide no direct patient care during the period of probation.

           The MFCU began an investigation after the matter was referred by the Massachusetts
   Department of Public Health (DPH). Investigators discovered that in July 2006, Aiguobargueghian
   was assigned to provide care to the victim. Aiguobargueghian physically assaulted the victim while
   the patient was in a wheelchair. These acts were witnessed by nursing home employees. After DPH
   investigated the matter, the case was referred to the MFCU for prosecution.

           On June 4, 2010, Aiguobargueghian was arraigned in district court where she entered a plea
   of not guilty and was released on personal recognizance. On February 1, after a two-day trial, the
   jury returned with a guilty verdict after deliberating for approximately three and a half hours. After
   the verdict, Aiguobargueghian was sentenced to serve two years of supervised probation.

          For further information contact Assistant Attorney General Gregory Matthews or Investigator
   Linda Landry (617) 727-2200.




                                                    18
Medicaid Fraud Report                                                            January/February 2011



   Resident Abuse: Texas

          Attorney General Abbott announced on December 16 that direct care worker Debra Lynn
   Garcia was given three years deferred adjudication community supervision and fined $750 after
   pleading guilty in state court to injury to a disabled individual. Garcia allegedly directed a group
   home resident to beat another resident and then physically abused the resident herself.

                                                   ****

           Attorney General Abbott announced on January 13 that certified nurses' aide Nicole Lashawn
   Bedford was sentenced in state court to 24 months incarceration after pleading guilty to injury to a
   child, elderly individual, or disabled person. While employed by Rockwood Manor Nursing Home,
   Bedford allegedly struck a resident's face and pushed the resident to the floor. At the time, Bedford
   was on probation for a prior felony assault.

          For further information on these cases contact Rick Copeland, Director or Chief Investigator
   Travis Tucker (512) 371-4700.

   Resident Abuse: Vermont

          Attorney General Sorrell announced on January 26 that an aide formerly employed at Cedar
   Hill Continuing Care Community was sentenced to a jail term based on her conviction for the abuse
   of a 93 year old resident of the nursing home. Keri Greenwood pleaded guilty in Superior Court on
   charges of abuse of a vulnerable adult and possession of a narcotic, both misdemeanors. The charges
   stem from Greenwood’s employment as a resident assistant at the facility. Greenwood removed
   fourteen Oxycodone pills, a narcotic painkiller, from a medication pack prescribed to the 93 year old
   resident for pain relief. Greenwood admitted to substituting the missing pills with a potentially
   dangerous antipsychotic drug, Risperdone, in place of the resident’s Oxycodone. Her actions
   deprived the elderly resident of her painkiller and put the resident at grave risk by exposing her to a
   powerful antipsychotic drug which she was not prescribed.

           As a result of her convictions, Greenwood received a total sentence of 16 to 24 months, all
   suspended with the defendant serving 30 days in jail. The court also imposed special probation
   conditions which will prohibit her from providing direct care to vulnerable adults and working in any
   setting where she would have access to narcotics. Greenwood was also ordered to perform 40 hours
   of community service.

          For further information contact Assistant Attorney General Linda A. Purdy (802) 828-5332.

   Resident Trust Funds: Florida

           Attorney General McCollum announced on November 17 that Jo Lynne Wigginton has been
   taken into custody on charges of exploiting a disabled adult. She was arrested by law enforcement
   officers with the Attorney General’s Medicaid Fraud Control Unit.



                                                     19
Medicaid Fraud Report                                                              January/February 2011



           Investigators determined that Wigginton exploited a nursing home resident by withdrawing
   thousands of dollars from the elderly adult’s bank account. Wigginton, who is not related to the
   patient, had access to the patient’s account to pay health related bills.

           Wigginton has been charged with one count of exploitation of an elderly or disabled adult, a
   third-degree felony. If convicted, she could receive up to five years in prison and a $5,000 fine.

                                                   ****

           Attorney General McCollum announced on December 10 that Reawattie Sugrim, owner,
   operator, and administrator of V&H Care Assisted Living Facility, was arrested by law enforcement
   officers with the Attorney General’s Medicaid Fraud Control Unit.

          Investigators determined that Sugrim obtained and used over $4,000 of a disabled adult’s
   money for purposes other than his benefit. Additionally, between December 2009 and March 2010,
   even though the disabled adult no longer resided at her facility, Sugrim billed and was paid for
   services she did not render.

           Sugrim has been charged with one count of grand theft and one count of Medicaid fraud, both
   third-degree felonies. If convicted, she faces up to ten years in prison and a $10,000 fine.

          For further information on both cases contact David Lewis, Director (850) 414-3600 or
   Acting Regional Chief David Bundy (813) 287-7940.

   Resident Trust Funds: Ohio

           Attorney General DeWine announced on December 6 that Kimberly Drzal was sentenced to
   five years of community control, ordered to pay court costs and pay restitution in the amount of
   $1,870.

           On August 23, 2010 a bill of information was filed charging Drzal with one count of theft, a
   felony of the fifth degree. Drzal pleaded guilty to one count of theft, a felony of the fifth degree.
   Drzal, stole patient funds from a nursing and rehab center and purchased gift cards with the money.

                                                   ****

           Attorney General DeWine announced on December 6 that Angela Rozeski was sentenced to
   five years of community control, ordered to pay court costs and $1,021 in restitution.

          On August 16, 2010, a bill of information was filed charging Rozeski with one count of theft,
   a felony of the fifth degree. Rozeski pleaded guilty to one count of theft, a felony of the fifth degree.
   Rozeski, stole patient funds from a nursing and rehab center and purchased gift cards with the money.

         For further information on both cases contact Assistant Attorney General Shawn Napier (614)
   466-0722.


                                                      20
Medicaid Fraud Report                                                           January/February 2011



   Resident Trust Funds: South Carolina

           Attorney General Henry McMaster announced on November 16 that Shirley Gause Anderson
   was convicted on November 16, 2010 of one count of breach of trust with fraudulent intent, value
   less than $1,000. On or about June 8, 2008, Anderson, while employed by Mental Health America, a
   provider for the Florence County Board of Disabilities and Special Needs, obtained funds owned by a
   client of Mental Health America.

           Anderson unlawfully converted the funds to her own personal use and purposes with the
   intent of permanently depriving the client of the use and benefit of said funds. She was sentenced to
   30 days suspended upon payment of restitution of $1,276.61 and a fine of $473.

          For further information contact Assistant Deputy Attorney General C. William Gambrell, Jr.,
   Assistant Attorney General Fay N. Scott, or Special Investigator David Addison (803) 734-3660.

                                                  ****

          Attorney General Alan Wilson announced on January 13 that Michelle Feagin was convicted
   of one count of exploitation of a vulnerable adult. On or about October 3, 2006, and continuing until
   on or about May 1, 2007, Feagin knowingly and willfully made improper, unlawful or unauthorized
   use of the funds, assets, property or power of attorney of a vulnerable adult who was a relative of
   Feagin and resided at Brian Center St. Andrews.

          Feagin was sentenced to one year suspended to five years probation, with credit for two days
   served, ordered to pay $4,500 in restitution terminable upon payment of all restitution and fees, is
   required to submit to random drug and alcohol testing and to submit a DNA sample.

          For further information contact Assistant Deputy Attorney General C. William Gambell, Jr.,
   Assistant Attorney General Sara McCartha or Chief Investigator James Bagnall (803) 734-3660.

                                                  ****

          Attorney General Wilson announced on January 20 that Julie K. Douglas was convicted of
   one count of breach of trust with fraudulent intent, one count of forgery and five counts of
   exploitation of a vulnerable adult. During the period on or about February 2009, until February 2010,
   Douglas, while employed as the business office manager at Westside Living Center, did unlawfully
   use the funds of vulnerable adults from the patient trust account for her own benefit. In addition,
   within the aforementioned time period, Douglas did commit the act of forgery and unlawfully used
   the funds of HMR Advantage Health Systems, Inc. for her own benefit.

          Douglas unlawfully used the funds of vulnerable adults at Westside Living Center and HMR
   Advantage Health Systems, Inc. in the amount of $21,695.19 without authorization. Douglas was
   sentenced to five years of confinement, suspended to five years probation and ordered to pay
   $21,695.19 in restitution.



                                                    21
Medicaid Fraud Report                                                            January/February 2011


          For further information contact Assistant Deputy Attorney General C. William Gambrell, Jr.,
   Senior Assistant Attorney General William K. Moore, or Chief Investigator James Bagnall (803) 734
   -3660.

   Resident Trust Funds: Texas

           Attorney General Abbott announced on November 17 that former Collinsville Care Center
   administrator Amber Christoffersen-Rogers received five years of deferred adjudication with 120
   days in county jail as a condition of the community supervision, and was ordered to perform 200
   hours of community service and write apology letters to each victim. Her spouse and former office
   manager William Dale Rogers, Jr., received five years of deferred adjudication with 180 days in
   county jail as a condition of the community supervision. He was barred from working at facilities for
   the elderly, and was ordered to perform 200 hours of community service, pay a $1,000 fine, and also
   write apology letters to all victims. Christoffersen-Rogers and Rogers are to pay shared restitution of
   $8,044.51.

           Christoffersen-Rogers and Rogers pleaded guilty to theft of property in October 2010. The
   two allegedly misappropriated over $8,000 from the resident trust and petty cash funds.

                                                   ****

           Attorney General Abbott announced on November 30 that Allen Sean Mitchell was indicted
   by a state grand jury for exploitation of the disabled. Mitchell, as a case manager for Daybreak HCS,
   was responsible for maintaining records of deposits and expenditures for the residents. He was also
   foster parent to three residents. Mitchell allegedly spent money belonging to residents of Daybreak
   HCS for his own use.

                                                   ****

           Attorney General Abbott announced on December 15 that certified nurse aide (CNA) Brittney
   Caines was indicted by a state grand jury for felony debit card abuse. Caines allegedly took a debit
   card from a resident at the Heritage Park Rehab and Nursing, and used the card for her own benefit

                                                   ****

           Attorney General Abbott announced on January 27 that Donna Elaine Moncrief was indicted
   by a state grand jury for felony theft and misapplication. As the business office manager at Songbird
   Lodge, Moncrief allegedly misappropriated the proceeds of insurance checks received on behalf of
   the nursing facility's residents by failing to properly deposit or account for the proceeds.

          For further information on these cases contact Rick Copeland, Director or Chief Investigator
   Travis Tucker (512) 371-4700.

   Speech Pathologists: Florida

         Attorney General McCollum announced on November 4 that Patricia Hernilda McCown, Ivis
   M. Plasencia Borges and Miriam Gonzalez were arrested on felony warrants by the Attorney

                                                     22
Medicaid Fraud Report                                                            January/February 2011



   General’s Medicaid Fraud Control Unit with assistance of the Miami-Dade Police Department.

           MFCU investigators discovered that the defendants, who are licensed as a speech language
   pathologist and assistants, were employed by The Center for Bilingual Speech and Language
   Disorders, Inc. (CBSLD). The investigation revealed that CBSLD and the defendants conspired to
   allow speech language assistants employed by CBSLD to provide unsupervised speech therapy to
   Medicaid recipients, who were mostly children, in violation of Florida statutes, Department of Health
   regulations and Medicaid program rules. CBSLD would then bill the Medicaid program while
   making it appear that the speech language pathologists had provided the therapy. A review of patient
   records seized by the Medicaid Fraud Control Unit pursuant to a lawful search warrant and a review
   of other documents revealed that between March 2006 and August 2009, CBSLD was paid over
   $239,000 by the Agency for Health Care Administration for these fraudulent claims.

          In July, MFCU investigators arrested four speech language pathologists and assistants
   employed by CBSLD for defrauding the Medicaid program out of nearly $540,000 by engaging in
   the same scheme.

          McCown is charged with grand theft, Medicaid fraud, both first-degree felonies and
   conspiracy to commit Medicaid fraud, a second-degree felony. If convicted of all charges, she could
   face up to $30,000 in fines and up to 75 years in prison. Borges is charged with grand theft, a first-
   degree felony and conspiracy to commit Medicaid fraud, a second-degree felony. If convicted of both
   charges, she could face up to $20,000 in fines and up to 45 years in prison. Gonzalez is charged with
   grand theft, a second degree felony and conspiracy to commit Medicaid fraud, a third-degree felony.
   If convicted of both charges, she could face up to $15,000 in fines and up to 20 years in prison.

          For further information contact David Lewis, Director (850) 414-3600 or Regional Chief Luis
   Martinez (305) 377-5441.

   CASE UPDATES

   Durable Medical Equipment: Texas

          Attorney General Abbott announced on November 4 that Emmanuel Nnadozie Gabriels
   pleaded guilty in federal court to conspiracy to commit health care fraud. Gabriels, Anthony Nnadi,
   Jasper Ogbonna, Kevin Onwudiwe, and Tony Ahi were indicted in January 2010 on multiple counts
   of conspiracy to commit health care fraud, health care fraud, and aggravated identity theft (See:
   Medicaid Fraud Report, January/February p. 10). Chimah Imoh was later charged with conspiracy to
   commit wrongful disclosure of individual identifiable health information. Onwudiwe pleaded guilty
   on October 5, 2010, to health care fraud.

          Gabriels delivered durable medical equipment for various DME providers, including Nicco
   Medical Services, owned by Nnadi. Nnadi allegedly exchanged recipient information with Ogbonna,
   owner of Matrix Medical Equipment and Supply. Aghaegbuna Odelugo, owner of a Texas ambulance
   service and a Texas DME company, allegedly sold Medicaid names and identifiers to Ogbonna.
   Matrix submitted Medicare crossover claims which were denied by Texas Medicaid; however, the
   Medicaid beneficiaries became victims of identity theft. Onwudiwe and Ahi both helped Nnadi

                                                    23
Medicaid Fraud Report                                                           January/February 2011



   operate Nicco and delivered durable medical equipment for various DME suppliers. All Medicaid
   crossover payments were denied.

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

   Medical Transportation: Texas

            Attorney General Abbott announced on December 8 that Royal Ambulance and First Choice
   EMS Ambulance company operations manager David Ray McNac was sentenced in federal court to
   41 of months incarceration with three years supervised release, and was ordered to pay $1,317,179.30
   in restitution. McNac pleaded guilty in April 2010 to conspiracy to commit health care fraud. McNac,
   company owner Nasir Usman and manager Shaun Outen were indicted in June 2009 for health care
   fraud, conspiracy to commit health care fraud, aiding and abetting, and money laundering (See:
   Medicaid Fraud Report, March/April 2010, p. 18 and May/June 2009, p.10). The three defendants
   allegedly directed the transportation of patients to dialysis facilities when those patients’ medical
   conditions did not warrant such transportation.

          Outen has pleaded guilty and is awaiting sentencing. Usman was convicted at trial and
   sentenced in October 2010 to 15 years incarceration and ordered to pay $1.2 million in restitution.
   The alleged Medicaid fraud is over $498,000 and the Medicare fraud is over $4 million.

                                                  ****

            Attorney General Abbott announced on January 5 that Royal Ambulance and First Choice
   EMS Ambulance company operations manager Shaun Jason Outen was sentenced in federal court to
   41 months incarceration, with three years supervised release, and was ordered to pay $360,189 in
   restitution. Outen, company owner Nasir Usman and operations manager David Ray McNac were
   indicted for health care fraud, conspiracy to commit health care fraud, aiding and abetting, and
   money laundering. The three defendants allegedly directed the transportation of patients to dialysis
   facilities when those patients’ medical conditions did not warrant such transportation.

          Usman was convicted at trial and sentenced in October 2010 to 15 years incarceration and
   was ordered to pay $1.2 million in restitution. McNac pleaded guilty and was sentenced in December
   2010 to 41 months incarceration and ordered to pay $1.3 million in restitution. (See: Medicaid Fraud
   Report, March/April 2010, p. 18 and May/June 2009, p.10). The identified Medicaid fraud is over
   $498,000 and the Medicare fraud is over $4 million.

          For further information on both cases contact Rick Copeland, Director or Chief Investigator
   Travis Tucker (512) 371-4700.




                                                    24
Medicaid Fraud Report                                                                        January/February 2011




           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

              Roy Cooper                     D. Mark Collins                       James McPherson
               President                         President                         Executive Director
           National Association            National Association                   National Association
                   of                                of                                    of
           Attorneys General             Medicaid Fraud Control Units              Attorneys General

           The views and opinions of authors expressed in this newsletter do not necessarily state or reflect
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                             Copyright 2011, National Association of Attorneys General




                                                           25
Medicaid Fraud Report                                                                                                  January/February 2011

                                                              INDEX OF CASES

     DENTISTS
     David Gonzales ........................................................................................................................ 2
     Kevin Oliver............................................................................................................................. 2

     DRUG DIVERSION
     Shirley Ann Risper ................................................................................................................... 2
     Pamela Taylor .......................................................................................................................... 3
     Paul Zavala............................................................................................................................... 3

     DURABLE MEDICAL EQUIPMENT
     Shirley Roberts Chavis ............................................................................................................ 4
     Adiodun Durojaiye................................................................................................................... 3
     Archibong Edem-Effiong, Eme Edem Edet, and Roslyn Hadnot Woodard ............................ 3
     Callistus Edozie ....................................................................................................................... 4
     Irma Cantu and Irma Linda Garcia .......................................................................................... 5
     Emmaniel Nnodozie Gabriels ................................................................................................ 23
     Howard Grant, MD .................................................................................................................. 5
     Chimah Imoh ........................................................................................................................... 4
     Linda E. Kendabie ................................................................................................................... 4
     Adeshola Oyenuga-Hasstrup ................................................................................................... 3
     Margaret Holmes Tukes ........................................................................................................... 5

     HEARING AIDS
     Mugeer Subhi Omar ................................................................................................................. 6
     Debra Spradlin ......................................................................................................................... 6

     HOME HEALTH CARE
     Phyllis Bell ............................................................................................................................... 7
     Fontane Bozeman................................................................................................................... 10
     Imogene Collins ..................................................................................................................... 10
     Steven Coward and Leslie Riggs ............................................................................................. 6
     Mark Geygen ........................................................................................................................... 8
     Eva Jo Hopson ......................................................................................................................... 8
     Marja Lawrence ....................................................................................................................... 8
     Keisha N. Marcano .................................................................................................................. 7
     Julie Mayle ............................................................................................................................... 9
     Demarlah Perkins ..................................................................................................................... 9
     Merranda Stacey ...................................................................................................................... 9
     Princewill Njoku and Clifford Ubani ....................................................................................... 8
     Christina Yates ......................................................................................................................... 7

     HOME HEALTH CARE AIDES ........................................................................................ 10

     HOSPITALS .......................................................................................................................... 11



                                                                            26
                                                        INDEX OF CASES


MEDICAL TRANSPORTATION
Awad Hassan ......................................................................................................................... 11
David Ray McNac.................................................................................................................. 24
Shaun Jason Outen ................................................................................................................. 24
Phillip Taylor ......................................................................................................................... 12
Anthony Dwayne Wilkerson.................................................................................................. 12

NURSES
Brandon Allen ........................................................................................................................ 14
Brenda Burmaster .................................................................................................................. 13
Nancy Engelhardt................................................................................................................... 12
Amy French ........................................................................................................................... 13
Myra Martinez ....................................................................................................................... 12
Heather Richardson ................................................................................................................ 13

NURSING HOMES .............................................................................................................. 14

PHARMACIES
Marcellis Jhekwuoba Anunobi .............................................................................................. 15
J. Harris Morgan .................................................................................................................... 14

PHYSICIANS
Edward Alexander Birts ......................................................................................................... 16
John Gholl .............................................................................................................................. 16
Charles Njoku ........................................................................................................................ 15
Veronica Scott ........................................................................................................................ 15
Harold Wagner, DO ............................................................................................................... 16

RESIDENT ABUSE
Nancy Aiguobargueghian ...................................................................................................... 18
James Brewster ...................................................................................................................... 17
Amanda Capers ...................................................................................................................... 17
Debra Lynn Garcia ................................................................................................................. 19
Keri Greenwood ..................................................................................................................... 19
Annette Holloman .................................................................................................................. 16

RESIDENT TRUST FUNDS
Shirley Gause Anderson ........................................................................................................ 21
Brittney Caines....................................................................................................................... 22
Amber Christoffersen-Rogers ................................................................................................ 22
Kimberly Drzal ...................................................................................................................... 20
Julie K. Douglas ..................................................................................................................... 21
Michelle Feagin ..................................................................................................................... 21
Donna Elaine Moncrief .......................................................................................................... 22
Allen Sean Mitchell ............................................................................................................... 22
                                                                      27
                                                      INDEX OF CASES

RESIDENT TRUST FUNDS (cont)
Angela Rozeski ...................................................................................................................... 20
Reawattie Sugrim ................................................................................................................... 20
Jo Lynne Wigginton ............................................................................................................... 19

SPEECH PATHOLOGISTS ................................................................................................ 22




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