MEDICAID FRAUD November 2006 Hidden Camera at New York Nursing Reveals Neglect . . . . . . 1 Cases . . . . . . . . . . . . . . . . . . . . . . 2 Case Updates . . . . . . . . . . . . . . . . 13 Hidden Camera at New York Nursing Home Reveals Neglect
Attorney General Eliot Spitzer announced on November 22 the arrest of nine employees of
the Hollis Park Manor Nursing Home in Queens, where a hidden camera revealed evidence ofwidespread patient neglect and falsification of patient records. Among those arrested was aphysician who served as the medical director of the nursing home, two licensed practical nurses andsix nurses aides.
According to the complaints, a secret camera was installed in the room of a patient and it
recorded care given to the patient over a five week period.
The camera revealed that the staff failed to provide required care for this patient as follows:
To prevent contractures, this patient’s physician ordered that the patient receive 30 minutesof range of motion therapy twice a day. The camera revealed that the patient consistentlydid not receive this therapy.
To prevent the development of dangerous pressure sores or promote their healing, the patientwas required to be turned and positioned every two hours and to receive incontinence careevery two hours as well, but the camera revealed that the patient often went without thiscare.
To ensure proper nutrition and hydration, the patient was supposed to receive total assistancewhile eating. The camera further revealed that the patient often failed to receive assistancein eating and often went without eating or drinking at all.
To avoid seizures, combat pressure sores, prevent depression, reduce pain, and tomaintainproper nutrition, the patient was required to receive a series of medications,including Tegretol, an anti-seizure medication, Celexa and Remeron, anti-depressants,Baclofen, a muscle relaxant and pain reducer, and a liquid protein nutrition supplement. The
Medicaid Fraud Report November 2006
camera revealed that the nurses charged often failed to administer these medications asprescribed.
The complaints further allege that in order to cover up their neglect, each of the defendants
falsified the patient’s care records to record that they had provided the required care that they had,in fact, not provided.
Dr. Howard Cohn, the former medical director of Hollis Park, is charged with two counts
each of Endangering the Welfare of an Incompetent or Physically Disabled Person, Wilful Violationof Health Laws (Patient Neglect), both misdemeanors, and Falsification of Business Records in theFirst Degree, an E Felony carrying a maximum prison term of four years. According to thecomplaint, Cohn claimed to have examined the patient on two occasions, once to conduct a monthlyphysical exam and once to treat lung and abdomen problems. In fact, the videotapes demonstratedthat he had entered the room of the patient on only one of the days and on that day all he did waspeer at the patient without conducting an examination.
The remaining defendants, listed below, are each charged with one count each of
Endangering the Welfare of an Incompetent or Physically Disabled Person and Wilful Violation ofHealth Laws (Patient Neglect) and multiple counts of Falsifying Business Records in the FirstDegree.
To date across the state, nine nursing home employees have been convicted based on
evidence produced by hidden cameras and 19 others, including the nine arrested in this case arefacing charges. In addition, one nursing home has been criminally charged and another has beensued. The investigation at Hollis Park Manor is continuing.
For further information contact Cassandra Bethel, Chief of the Patient Protection Section
Adult Day Care Centers: South Carolina
Attorney General Henry McMaster announced that Roxie Z. Amburn, Assistant Director of
Piedmont Adult Day Care Center, Spartanburg, South Carolina, was convicted on November 1 of
Medicaid Fraud Report November 2006
one count of Filing False Claims. On or about February 11, 2005, Amburn caused a false claim tobe filed with the South Carolina Medicaid Program for services that had not been provided.
Amburn was sentenced by the Honorable Ernest J. Kinard, Jr. to three years, suspended upon
90 days or payment of a $200 fine ($540, including costs) and was ordered to pay restitution to theSouth Carolina Department of Health and Human Services in the amount of $2,500 plusinvestigative costs.
For further information contact Assistant deputy Attorney General Charles W. Gambrell, Jr.,
Assistant Attorney General T. Scott Beck, Chief Investigator Harry Bracy, or Special InvestigatorKyle Mitchum (803) 734-3660. Dentists: Florida
Attorney General Charlie Crist announced on November 2 that Lorenzo Puentes, a dentist
and Francisco Torres, the owner of the dental clinic where both men worked, were arrested for theirinvolvement in a scheme that defrauded the Medicaid program out of more than $20,000.
The Medicaid Fraud Control Unit launched an investigation last October into allegations that
an unlicenced dentist was performing dental work on patients. Orlando Sotolongo was arrested inMarch for posing as dentist Lorenzo Puentes. Sotolongo worked with Puentes at Puentes DentalServices, a Miami clinic managed by Torres. The investigation, which continued after Sotolongo’sarrest, determined that both Puentes and Torres were aware that Sotolongo was not a licenced dentistbut allowed him to continue treating patients, providing invasive dental services such as extractionsand issuing prescriptions for antibiotics and painkillers. After Sotolongo treated the patients, Puenteswould sign the patient chart as if he had provided the services himself.
Patient charts were used to submit claims to the Medicaid program, using Puentes’ Medicaid
provider number indicating he had actually treated the patients. Torres and Puentes received morethan $20,000 in fraudulent reimbursements from the Medicaid program.
For further information contact Rick Lober, Director (850) 414-3600. Dentists: Texas
Attorney General Greg Abbott announced on November 29 that Dr. John Antle and his wife
Gloria Antle were indicted by a grand jury on one count each of Medicaid Fraud. Dr. and Mrs. Antleoperated Saratoga Dental in Corpus Christi, Texas. A record review by the MFCU's contract dentistfound discrepancies in 95 of 98 medical records from Saratoga Dental. Three of the records wereverified using a Saratoga Dental claims data report. For the time period between 2000 to present,Saratoga was paid $634,010 by the Medicaid program.
For further information contact Rick Copeland, Director MFCU or Chief Investigator Jim
Medicaid Fraud Report November 2006 Drug Diversion: Texas
Attorney General Abbott announced on November 1 that Rayne Torres pleaded guilty to
forging controlled substance prescriptions. He was sentenced to deferred adjudication and fined. Hewas also ordered to pay restitution to Medicaid for $4,848.19 for controlled substances that he andhis wife Vanessa Torres diverted by forged prescriptions. Vanessa has already pled guilty. Additionally, he was ordered to pay $497.24 in court costs. Rayne and Vanessa were investigatedby MFCU, the Texas Department of Public Safety - Narcotics Division and the Vendor DrugProgram Regional Pharmacist. The investigation involved prescription pads stolen from TheNeurological Clinic and used to obtain controlled substances that were billed to Medicaid.
Attorney General Abbott announced that on November 7 a grand jury indicted Licensed
Vocational Nurse (LVN) Christopher Ferguson, on a 2nd degree felony count of FraudulentPossession of a Controlled Substance/Prescription. Ferguson was alleged to have diverted painmedications from residents of Southwood Nursing Home.
Attorney General Abbott announced on November 14 that Licensed Vocational Nurse (LVN)
Suzanna Kate Smith was indicted by a grand jury. The indictment is based an event where LVNSmith was found by facility staff to be in possession of two blister packs of Vicoden belonging toa deceased resident. When interviewed about the narcotics, LVN Smith admitted to taking thenarcotics for her own personal use.
Attorney General Abbott announced that on November 22 a grand jury indicted Registered
Nurse (RN) Judith Ann Boyd on charges of Obtaining a Controlled Substance by Fraud, a seconddegree felony, as well as Tampering with a Governmental Record with the Intent to Defraud andHarm, a third degree felony. The charges are based on the results of an investigation by the MFCUwhich revealed that on October 8, 2005, RN Boyd falsified government required narcotics recordswhile employed as a nursing supervisor at Red Oak Health and Rehabilitation Center. She did sofor the purpose of diverting, for her own personal use, a blister pack containing thirty tablets of"Hydrocodone," a controlled substance, narcotic medication.
For further information on these cases contact Rick Copeland, Director or Chief Investigator
Medicaid Fraud Report November 2006 Durable Medical Equipment: Ohio
Attorney General Jim Petro announced on May 16 that Richard Carroll was indicted on one
count of Medicaid Fraud, a felony of the third degree. On October 4 Carroll entered a plea of guiltyto one count of Medicaid Fraud, a felony of the fourth degree. On November 21 Carroll wassentenced to five years of probation, ordered to pay restitution in the amount of $369,555.44, andordered to pay $10,708.55 in investigative costs. Carroll, owner of Safe Transit, Inc, was responsiblefor transporting ambulatory clients, in violation of Medicaid regulations.
For further information contact Associate Assistant Attorney General Claude Nicholson
Home Health Care Aides: Arizona
Attorney General Terry Goddard announced the sentencing of Mary Ann Dubla on
November 28. Dubla was sentenced to three years probation and ordered to pay restitution to NewHaven Support Services of $4,626, $5,967.61 to UCP of Central Arizona and $4,805.12 to AHCCCSfor a total of $15,398.73. Dubla entered a plea agreement with the State of Arizona on October 25pleading guilty to amended Count 13 of Criminal Possession of a Forgery Devise.
From January 21, 2001, through March 5, 2004, Mary Ann Dubla, aka Mary Hagey obtained
payment for services that she never provided as a caregiver of habilitation respite services. Dublaworked through multiple agencies that would provide caregivers to Medicaid clients. Those clientsmight be autistic, or severely to moderately mentally retarded. She also provided respite services,as a relief measure to parents. It is alleged that the defendant submitted false claims with forgedsignatures for services that she never gave for a loss to the government of $15,398.73.
For further information Steven Duplissis, Director (602) 542-3881. Home Health Care Aides: Ohio
Attorney General Petro announced on August 15 that Schelena Braxton was indicted on one
count of Medicaid Fraud, a felony of the fifth degree. On November 2 Braxton entered a plea ofguilty to one count of Medicaid Fraud, a misdemeanor of the first degree and was sentenced toninety days in prison; suspended, three years of probation, and ordered to pay restitution in theamount of $3,000, to be paid in monthly installments of $100 during the probation period.
Braxton is the mother of a home health recipient. She had a kickback arrangement with the
provider, who was also indicted and is awaiting trial.
For further information contact Senior Assistant Attorney General Constance Nearhood
Medicaid Fraud Report November 2006
Attorney General Petro announced on June 20 that Katie Herman was indicted on one count
of Medicaid Fraud, a felony of the fifth degree. On November 13, Herman entered a plea of guiltyto one count of Medicaid Fraud, a misdemeanor of the first degree and was sentenced to ten daysin prison; suspended, ordered to pay a fine of $100, and to pay restitution in the amount of$2,536.50.An independent provider, Herman submitted claims for multiple consumers for the exactsame time period.
For further information contact Deputy Attorney General Jordan Finegold (614) 466-0722.
Attorney General Petro announced on May 16 that Shawnette Jiminez was indicted on one
count of Medicaid Fraud, a felony of the fourth degree. On November 14, Jiminez entered a pleaof guilty to one count of Medicaid Fraud, a misdemeanor of the first degree and was sentenced to180 days in prison; suspended, two years probation, and ordered to pay restitution in the amount of$5,052.
During a trip from September 25, 2005 to November 14, 2005, Jiminez, an independent
provider, billed for services that were never provided. Jiminez did not accompany the recipient onthe trip in question but billed as if she had.
Attorney General Petro announced on August 15 that Karl Mertz was indicted on one count
of Medicaid Fraud, a felony of the fifth degree. On November 30, Mertz entered a plea of guilty toone count of Medicaid Fraud, a felony of the fifth degree and was sentenced to five years probation,and ordered to pay restitution in the amount of $7,800. Mertz, an independent provider, billed forservices during a time period in which the recipient was admitted to a hospital.
For further information on both cases contact Senior Assistant Attorney General Constance
Attorney General Petro announced on January 17 that Tenia White was indicted on one count
of Medicaid Fraud, a felony of the fourth degree. On July 31 White entered a plea of guilty to onecount of Medicaid Fraud, a felony of the fifth degree. On November 15 White was sentenced to tenmonths in prison; suspended, five years probation, ordered to pay court costs, and restitution in theamount of $23,484.
White, an independent provider, billed for services not authorized. The complaint was made
by a current provider who had billings returned as "exceeding maximum benefits for the consumer."White was not as an authorized provider, yet billed Medicaid for services.
Medicaid Fraud Report November 2006
For further information contact Associate Assistant Attorney General Claude Nicholson
Home Health Care Aides: South Carolina
Attorney General McMaster announced that Meketa Hall, a PCA with All Caregivers, Inc.,
was convicted on November 1 of one count of Filing False Claims. On or about August 1, Hallcaused a false claim to be filed with the South Carolina Medicaid Program for services that had notbeen provided.
Hall was sentenced by the Honorable Ernest J. Kinard, Jr. to three years suspended to two
years probation. The defendant is required to pay the balance of her restitution ($2,286.25) to AllCaregivers, Inc. during the two years of probation plus court costs of $128.75.
For further information contact Assistant Deputy Attorney General Charles W. Gambrell,
Jr., Assistant Attorney General Teresa Shealy, or Special Investigator Kyle Mitchum (803) 734-3660. Home Health Care Aides: Vermont
Attorney General William Sorrell announced on September 25 that Heather Bright pleaded
guilty in Franklin District Court to two misdemeanor counts of financial exploitation of vulnerableadults. Bright admitted to submitting false time sheets for personal care services to two vulnerableadults even after she had discontinued being the provider of service for the vulnerable adults. Brightmust make $1,776 in restitution to Medicaid and received a one to two years suspended sentencewith probation. Her probation conditions include successful completion of reparative probation andthat she not work for vulnerable adults for four years. She may also face a sanction by the federalOffice of the Inspector General regarding her employment in any Medicaid or Medicare program.
For further information contact Linda Purdy, Director (802) 241-4440. Medical Clinics: South Carolina
Attorney General McMaster announced that James Kelvin Johnson, owner of We Care
Enrichment Center, was convicted on November 1 of one count of Filing False Claims. On or aboutDecember 10, 2005, Johnson caused a false claim to be filed with the South Carolina MedicaidProgram for services not provided.
Johnson was sentenced by the Honorable Ernest J. Kinard, Jr. to three years, suspended upon
five years probation, ordered to pay restitution and investigative costs, court costs of $128.75 andsix months home detention. Restitution in the amount of $30,212.61 is to be paid to the SouthCarolina Department of Health and Human Services. Medicaid Fraud Report November 2006
For further information contact Assistant Deputy Attorney General Charles W. Gambrell,
Jr., Assistant Attorney General T. Scott Beck, Chief Investigator Harry Bracy, or SpecialInvestigator Kyle Mitchum (803) 734-3660. Medical Transportation: Vermont
Attorney General Sorrell announced on September 25 that Donna Morgan pleaded guilty to
one felony count of Medicaid Fraud on September 21 in Vermont District Court. The convictionstemmed from Morgan submitting false claims under a Medicaid funded transportation serviceprogram, stating that she provided her family member, a Medicaid recipient, with transportation,when she in fact did not. The papers filed with the court stated the total amount stolen by Morganthrough the filings of false claims is over $10,000. Since the crimes occurred, Morgan has sufferedsevere health problems.
Morgan was sentenced to one to two years, all suspended on probation. Her probationary
conditions include restitution of $10,800 to Medicaid.
For further information contact Linda Purdy, Director (802) 241-4440. Nurses: New Jersey
Attorney General Stuart Rabner announced that Frances M. Colon-Torres has been sentenced
for using phony nursing licenses to obtain employment at a nursing home.
She was ordered by Superior Court Judge Stephen Bernstein in Essex County to serve two
years probation, during which she is barred from working in the health care field, and to pay $18,000in fines and restitution. In addition, Colon Torres was ordered to attend mandatory psychologicalcounseling. Colon Torres was sentenced following her November 13 guilty plea to two counts eachof false government documents, theft by deception and uttering a forged document, all third degreecrimes.
Colon Torres admitted that in August 2004, she submitted a false license to Premier Nursing
Home to be hired as a licensed practical nurse. As an LPN, Colon Torres dispensed medication topatients. In May 2005, Colon Torres presented a false registered nurse license to Premier Nursingand was subsequently promoted. As an RN, Colon Torres did assessments of patients and tookphone orders from doctors for medications, which only registered nurses are authorized to do. Asa result of the fraud, she was paid more than $37,500 for a job for which she was not qualified.
For further information contact Deputy Attorney General Yvette Gibbon (973) 599-5871. Medicaid Fraud Report November 2006 Nurses: South Carolina
Attorney General McMaster announced that Elizabeth A. Cramer, a registered nurse with
Palmetto Health Homecare, was convicted on November 28, 2006 of one count of Filing FalseClaims. On or about September 2, 2005, she filed a false claim with the South Carolina MedicaidProgram for services that had not been provided.
Cramer was sentenced by the Honorable L. Casey Manning to three years and $1,000,
suspended upon three years probation and restitution of $1,482 to Palmetto Health Homecare. Probation may be terminated upon full payment of restitution.
For further information contact Assistant Deputy Attorney General Charles W. Gambrell,
Jr., Assistant Attorney General Scott Beck, Special Investigator Kyle Mitchum or Chief Investigator Harry Bracy (803) 734-3660. Nurses: Texas
Attorney General Abbott announced on November 16 that a grand jury indicted Certified
Nurse Aide (CNA) Judy Irene Houze on one count of Fraud/Use/Possession of IdentifyingInformation (Identity Theft). The indictment was based on an allegation that Houze had exploiteda nursing home resident by taking and using the resident's drivers license and Social Securityinformation to obtain cell phones for her personal use.
For further information contact Rick Copeland, Director or Chief Investigator Jim Fossom
Patient Abuse: New York
Attorney General Spitzer announced on September 7 that a certified nurse aide formerly
employed at the Auburn Nursing Home has been charged with physically abusing an elderly andincompetent patient suffering from dementia.
Shanika N. Williams appeared before Judge Michael McKeon in the Auburn City Court and
was charged with one count of Willful Violation of Health Laws and one count of Endangering theWelfare of an Incompetent or Physically Disabled Person arising from her care of a patient of theAuburn Nursing Home. The charges allege that she struck the patient on her face, producing a bruisenear her mouth.
Williams had been working at the Auburn Nursing Home for about one month until she was
terminated from employment on May 16, due to her alleged conduct.
For further information contact Special Assistant Attorneys General Norman S. Hatt (315)
Medicaid Fraud Report November 2006 Patient Abuse: Ohio
Attorney General Petro announced on September 9, 2005 that Jean St. Hilaire was indicted
on one count of Patient Abuse, a felony of the fourth degree. On November 21, He entered a pleaof guilty to one count of Patient Neglect, a misdemeanor of the second degree and was sentencedto three months in prison; suspended, ordered to pay a fine in the amount of $300 and ordered to paycourt costs.
St. Hilaire, an employee of Broadview Health Center became frustrated with a combative
resident, and shoved him into a bed rail, causing a 1x2 cm laceration. St. Hilaire was terminatedafter an internal investigation.
For further information contact Senior Deputy Assistant General Keesha Mitchell (614) 466-
Patient Abuse: Texas
Attorney General Abbott announced on November 14 that a grand jury indicted Christopher
Lee Thompson on one charge of Aggravated Sexual Assault. The charge stems from an August 16incident where he was discovered, by a staff member, laying on top of a resident in the resident'sroom at Mission Oaks Care Center, Sherman, Texas. Thompson was detained and subsequently gavean oral, video taped confession to detectives at the Sherman Police Department.
For further information contact Rick Copeland, Director or Chief Investigator Jim Fossom
Patient Neglect: New York
Attorney General Spitzer announced on October 26 that the indictment and arraignment of
the corporation that operates a nursing home on charges alleging patient neglect and falsifyingmedical records. The indictment was brought by the same grand jury that previously indictedemployees of the home who were captured on surveillance cameras neglecting their patients.
The corporation, Highgate LTC Management LLC, the company that owns and operates the
Northwoods Nursing Home, also has interests in five other facilities in upstate New York. It has nowbeen charged with six counts of Wilful Violation of Health Laws and three counts of FalsifyingBusiness Records in the Second Degree.
The charges against Highgate LTC Management LLC arise from an undercover investigation
by the Medicaid Fraud Control Unit during which Unit investigators installed a hidden video camerain the room of a comatose patient.
According to the charges filed in this case and in the cases against Highgate's employees, this
video surveillance showed numerous instances in which Highgate employees failed to deliver
Medicaid Fraud Report November 2006
services required by the patient's care plan and numerous instances where those employeesnonetheless falsely recorded in the patient's medical records that the services had been given.
For further information contact Ralph Tortora III, Syracuse Regional Director (315) 423-
Patient Trust Funds: Ohio
Attorney General Petro announced on August 18 that Greg Hall was indicted in Hamilton
County on one count of Theft, a misdemeanor of the first degree. On November 16, Hall entereda plea of guilty to one count of Unauthorized Use of Property, a misdemeanor of the fourth degreeand was sentenced to pay a fine of $250, and ordered to pay restitution to the victim in the amountof $1,000.
While employed in a nursing home, Hall became responsible for patient funds and
subsequently was suspected of misappropriation. Hall admitted to agents that he deposited $1,000into his personal account from a resident's account.
For further information contact Associate Assistant Attorney General Claude Nicholson
Patient Trust Funds: South Carolina
Attorney General McMaster announced that Careamerica, Inc. d/b/a Meadows of Conway,
an assisted living facility was convicted of 16 counts of Exploitation of a Vulnerable Adult onNovember 17. Between on or about May 2005 and continuing until on or about March 2006,Careamerica made unauthorized, improper or illegal use of the funds or assets of residents ofMeadows of Conway. The value of the funds for the residents totaled $13,686.81.
The corporation was sentenced by the Honorable Ferrel Cothran to pay a total fine of $5,320
by December 5. The corporation has made restitution of $13,686.81 in these cases.
For further information contact Assistant Deputy Attorney General Charles W. Gambrell,
Jr., Senior Assistant Attorney General William K. Moore, Chief Investigator James Bagnall orInvestigator Tom Quin (803) 734-3660. Patient Trust Funds: Texas
Attorney General Abbott announced on November 7 that a grand jury indicted business
manager Lola Stewart for Felony Three Theft. Stewart was the business manager of OvertonHealthcare Center Nursing Home from 1999 to August 2005. Stewart is accused of diverting appliedincome checks thru her grandmother's trust fund balance. Stewart's grandmother was a resident ofthe nursing home and a trust fund participant. Additionally, Stewart made substantial cash depositsinto her personal account after cashing trust fund checks under the guise of replenishing the trustfund. The amount of theft identified totaled $72,735.49. Medicaid Fraud Report November 2006
For further information contact Rick Copeland, Director or Chief Investigator Jim Fossum
(512) 371-4700. Pharmacies: Arizona
Attorney General Goddard announced on November 13 that an 11 count indictment was filed
against four defendants on charges of fraud, theft and possession of narcotic for sale and othercharges.
Richard James Solano, Ryan Eugene Lodge, Amoreena Sneed Becher, and Nicolas Mark
DeGroot were indicted on charges of conspiring to obtain and later sell prescription narcotic drugs. A fifth defendant has been indicted but has not been served with the charges.
According to the indictment, between June and December 2005, Solano and Lodge used their
positions as pharmacy technicians at CVS Pharmacy to obtain patient and doctor information toforge prescriptions. At the time of their arrest, Solano and Lodge were in possession of various typesof narcotic drugs like morphine, codeine, carisoprodol and diazepam valued at more than $25,000.
Solano and Lodge were indicted on one count each of fraud, theft, possession of narcotic for
sale, possession of a dangerous drug for sale, illegally conducting an enterprise, obtaining a narcoticby fraud, and forgery. Becher and DeGroot were indicted on one count each of possession of anarcotic drug, possession of a dangerous drug and tampering with evidence.
For further information contact Steven Duplissis, Director (602) 542-3881. Physicians: Kentucky
Attorney General Greg Stumbo announced on November 16 that a grand jury returned a
twenty two count indictment against Michael Vories, M.D., and his pain management clinic, Simon& True Medical Consultants (now known as Kentucky Palliative Care). The indictment alleges thatVories committed fraud by submitting false and/or fraudulent claims to the Kentucky Medicaidprogram.
In the twenty two counts of the indictment, Dr. Vories and his clinic are faced with Class D
felony charges which carry a punishment of up to five years in prison for each count. Dr. Vories iscurrently residing in South Carolina and will be arraigned on these charges as soon as he is returnedto the state.
For further information contact Pam Murphy, Director (502) 696-5405. Medicaid Fraud Report November 2006 Psychologists: Texas
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