2005 Health Care Fraud Repot

Ohio Attorney General’s Office Report on Health Care Fraud

2005

ANNUAL REPORT FOR CALENDAR YEAR 2005

OF THE

OHIO ATTORNEY GENERAL’S HEALTH CARE FRAUD SECTION

State of Ohio Office of the Attorney General Jim Petro, Attorney General

30 E. Broad St., 17th Fl. Columbus, OH 43215-3428 Telephone: (614) 466-4320 Facsimile: (614) 466-5087 www.ag.state.oh.us

Dear Fellow Ohioan: The crime of Medicaid Fraud costs the State of Ohio millions of dollars each year. That money comes from the pockets of taxpayers like you. Fraudulent Workers’ Compensation claims result in higher Workers’ Compensation insurance costs for businesses, which are forced to pass that cost along to their customers. Every citizen of Ohio could be affected by these illegal activities. Throughout the State, one of the most vulnerable segments of the population, our senior citizens, are abused and neglected in nursing homes. These victims are abused by the very people who are paid to care for them. Many times, the family and friends of the victims are unaware of the abuse because advanced illness or simple fear prevents the victims from voicing their plight. Who will protect the taxpayers’ money from being used to fund the Medicaid benefits that provide medical assistance for the economically disadvantaged in our communities? Who will fight for the businesses of Ohio to ensure that Workers’ Compensation insurance costs remain affordable? Who will protect our elderly citizens in nursing homes and prosecute the people who would abuse or neglect them? The Health Care Fraud Section of the Ohio Attorney General’s Office works hard every day to do just that. This group of highly committed attorneys, investigators and support personnel take the daunting tasks before them very seriously, and the results of their efforts, especially during the last three years, have been nothing but incredible. I am pleased to present this report of the activities of my Health Care Fraud Section. I am very proud of the work of the staff in my Health Care Fraud Section. Since taking office in 2003, I have focused on protecting the most vulnerable members of our state, and the Section has accomplished much in that regard. Over the last three years, the Health Care Fraud Section has been responsible for over 556 criminal convictions, 24 civil settlements, and more than $73 million dollars in financial recoveries to the State of Ohio. Very Truly Yours,

Jim Petro Attorney General

TABLE OF CONTENTS

Section

Page No.

Introduction ................................................................................................. 1 The Health Care Fraud Section ................................................................. 2 Source of MFCU Workload ...................................................................... 3 Section Accomplishments.......................................................................... 5 Medicaid Fraud Control Unit.............................................................. 5 Medicaid Fraud Cases .................................................................... 6 Patient Abuse Cases........................................................................ 8 Misappropriation Case................................................................... 10 Workers’ Compensation Fraud Unit.................................................. 10 Workers’ Compensation Fraud Cases.......................................... 10 Conclusion ................................................................................................... 12

Attachments A – Key Legislation Related to Health Care Fraud.......................... 13 B - Listing of MFCU 2005 Convictions............................................... 15 C- Listing of WCFU 2005 Convictions ............................................... 25

HEALTH CARE FRAUD Introduction The Ohio Medicaid Program is a state-run program, providing assistance to low-income individuals who cannot afford to pay for their own health care. Ohio Medicaid also finances acute and long-term care services for low-income children and approximately one-half million elderly and disabled individuals. The program is administered by the Ohio Department of Job and Family Services (ODJFS). Health care professionals become Medicaid providers by entering into a contract with ODJFS, agreeing to provide goods and/or services to Medicaid recipients and to accept as payment the set dollar amounts that Medicaid reimburses for those goods or services. Most Medicaid providers abide by the rules of their contract and provide excellent services to Medicaid recipients. A few providers, though, choose to take advantage of the system and the taxpayers who fund it, by committing Medicaid fraud. There are many ways in which a provider might attempt to defraud the Medicaid program. One is to bill for services which were never rendered. An example of this would be a dentist who bills Medicaid for an x-ray that was never taken, or a medical supply company that bills for dialysis test kits which were never supplied to the Medicaid recipient. Another way a provider can commit Medicaid Fraud is to bill Medicaid for services to the recipient that are medically unnecessary. An example would be a facility with a new computer tomography (known as a CAT scan machine) sends all patients regardless of their complaint to have a CAT scan. Medicaid Fraud can also occur in the form of illegal “kickbacks.” This would occur if, for instance, the owners of a laboratory sent a doctor free airline tickets, in exchange for the doctor sending all of his lab work to that facility. All of these schemes are illegal and drain precious money from the Medicaid Program that could be used to provide medical services to our most economically disadvantaged citizens. The Workers’ Compensation Law of Ohio states that employees who are injured or who contract occupational diseases during the course of their employment are entitled to have related medical bills paid from the Workers’ Compensation Fund for that employer. Two separate agencies administer Ohio’s Workers’ Compensation program: the Ohio Bureau of Workers’ Compensation (BWC) and the Industrial Commission of Ohio (IC). The BWC is responsible for

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collecting insurance premiums from employers, overseeing the integrity of the insurance system and paying out legitimate claims. The IC steps in when a BWC claim is disputed. Fraud against the Workers’ Compensation program can occur in many ways, and by providers, claimants, and employers. The most common example of fraud is a claimant who fabricates an injury or exaggerates the severity of an injury in order to receive Workers’ Compensation benefits. But, health care providers can commit fraud against the program, as well, and usually in much the same way that providers commit Medicaid Fraud – by billing for services not rendered and billing for medically unnecessary services. Employers can also defraud the program by intentionally underreporting the amount of premiums that they owe to the program. There are over 75,000 people residing in nursing homes in the State of Ohio. Patient Abuse occurs when an owner, employee or agent of a care facility knowingly causes physical harm or recklessly causes serious physical harm to a resident, or causes physical harm by the inappropriate use of physical or chemical restraint, medication or isolation of the resident. Patient Neglect occurs when an owner, employee or agent of a care facility knowingly causes physical harm or recklessly causes serious physical harm by failing to provide a resident with any treatment, care, goods or services that are necessary to maintain the resident’s health or safety. There are many reasons why employees of a care facility might abuse or neglect the people under their care. They may become angry or frustrated because of the demands placed on them by the specialized needs of the residents, or they may simply suffer from a lapse of judgment. In any case, these perpetrators need to be held accountable for their actions, and decisive steps need to be taken to ensure that they are never again placed in a position where they might commit abuse again. The Health Care Fraud Section The Health Care Fraud Section of the Ohio Attorney General’s Office is divided into two units: the Medicaid Fraud Control Unit and the Workers’ Compensation Fraud Unit. These two units work diligently to combat the criminal behavior previously described. The Medicaid Fraud Control Unit (MFCU) has been in existence for twenty-seven years. It grew from a small organization with a handful of cases to its current activity level which involves about 700 cases annually. Today the MFCU consists of four teams of highly trained investigators, several dedicated criminal prosecutors and an array of multi-talented support staff. Three of these teams, consisting of eighteen Special Agent investigators and six prosecutors,

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focus their efforts exclusively on investigating allegations of Medicaid fraud and prosecuting the individuals who commit this criminal act. Only Medicaid providers – the people who provide health related goods and services to the Medicaid recipient population – are investigated by the Unit. These providers include doctors, dentists, pharmacies, medical goods suppliers and home care aides to name only a few. The MFCU’s fourth team, consisting of six Special Agents, investigates allegations of abuse and neglect in Ohio’s nursing homes. These cases are guided by the same attorneys who handle the Unit’s Medicaid Fraud cases, but the cases are most often prosecuted in the county where the abuse or neglect occurred. The Unit also has a “Special Projects” team which assists the unit in utilization data collection and analysis, and otherwise works with investigators to develop fraud cases. The Workers’ Compensation Fraud Unit (WCFU) consists of six attorneys who prosecute cases of Workers’ Compensation Fraud. The cases are investigated by Special Agents from BWC, and when these investigators find evidence of criminal activity, they refer those cases to the WFCU for prosecution of the wrong-doers. Source of MFCU Workload The MFCU’s workload is complaint driven. This means the primary source for its work is complaints from citizens, Medicaid recipients, the provider community, and other sources. The unit also receives referrals from the Ohio Department of Job and Family Services, Ohio Department of Health and other government agencies, as well as law enforcement agencies. We receive complaints through the Attorney General’s website, through the [email protected] e-mail, postal mail, 1-800 telephone calls, and the referral process. The number of potential cases for investigation has grown steadily between the years 2000 and 2005. As shown by the following chart, intakes have increased from 435 in 2000 to 698 in 2005.

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During 2005, we received and processed 698 intakes of fraud, abuse, neglect, and misappropriation of patient property. The sources for these cases are depicted in the following table:

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In addition to the varied sources of our work, the type of Medicaid provider referred for investigation also covered a broad spectrum. The provider types involved in the 698 complaints are depicted below by type and by total:

Section Accomplishments Over the last three years, the Health Care Fraud Section has been responsible for over 556 criminal convictions, 24 civil settlements, and more than $73 million dollars in financial recoveries to the State of Ohio. These figures represent large increases in both convictions and recoveries over previous years, and the Section is striving to continue that trend into the future. During 2005, the Section investigated 841 cases, filed criminal charges against 233 individuals or companies, and obtained 201 convictions. In addition, the Section secured more than $18.3 million in civil and criminal restitution and penalties and was reimbursed for $115 thousand in investigative costs.

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Medicaid Fraud Control Unit In 2005 the MFCU generated Medicaid restitution and penalties of over $17 million in civil and criminal settlements, received 698 allegations of fraud and abuse, criminally charged 110 providers, and secured convictions against 75 providers. Convicted providers were ordered or agreed to reimburse the Unit for over $115 thousand in investigative costs. All individuals or companies convicted of Medicaid fraud or patient abuse or neglect are mandatorally excluded from participation in the Medicare/Medicaid program for at least five years. Medicaid Fraud Cases What is Medicaid Fraud? Under ORC 2913.40, Medicaid fraud occurs when a Medicaid provider knowingly makes or causes to be made a false or misleading statement or representation for use in obtaining reimbursement from the medical assistance program. This would include, but is not limited to, billing for services not provided, billing for higher level services than were actually provided, and providing services that were medically unnecessary. The following represent a few cases which were prosecuted in 2005: The MFCU recently completed its two year investigation of various Ambulette providers. An ambulette is a wheelchair van. The Medicaid program pays for the transport of wheelchair bound patients to Medicaid covered appointments, such as dialysis or a doctor visit. In order to be covered, the transport must be of a wheelchair bound patient, who is seated in a wheelchair, and who is transported in an actual wheelchair van or ambulette. This investigation included providers in Richmond Heights, Struthers, Cleveland, South Euclid, Jacksonville, Beachwood, Columbus and Mayfield Heights. The investigation revealed that while the fraud by these providers takes place in many variations, the primary method is for the transportation companies to transport patients who are fully capable of walking, and who are transported while sitting in regular passenger seats. The companies then billed the Medicaid program indicating that the patients had required wheelchair transportation and were transported while seated in a wheelchair. The MFCU obtained twenty convictions against ambulette company operators and obtained restitution orders for nearly $1.7 million. Some of these convictions are the result of collaboration with the FBI and the US Attorney’s Office, while other convictions have been obtained solely by the MFCU. The MFCU received a referral from the Ohio Department of Job and Family Services regarding possible Medicaid fraud by two home health providers. The investigation quickly revealed that the mother of the recipient was allowing her sons’ three providers to bill for services not rendered and then requiring the providers to kickback approximately 25% of all their Medicaid billings to her. The providers were 6

billing for between 24 and 30 hours a day for care to recipients who were only mildly handicapped. The recipients’ mother was convicted of Medicaid Fraud and was required to pay back $67,854.00. Each provider was convicted of Medicaid Fraud and required to return $18,528.00, $16,667.00 and $32,000.00 respectively. The owner of the Cleveland, Ohio based Guardian Health Services caused Guardian to bill for two nursing services a day for residents of a residential care facility when only one visit was provided. The owner also provided false statements to banks to obtain loans. The MFCU, working with the Department of Justice, filed a Bill of Information in Federal District Court for the Northern District of Ohio charging the owner with 5 counts of Bank Fraud and 1 count of Making a False Statement in a Health Care Matter. On March 16, 2005, the owner pleaded guilty to all counts of the Bill. On May 25, 2005, the owner was sentenced to 37 months in federal prison and ordered to pay restitution in the amount of $32,951.70. Cardiodiagnostic Services’ owners caused Cardiodiagnostic to bill for diagnostic testing that was not performed. One owner also forged signatures on checks received from Medicaid and Medicare payable to doctors that no longer worked for Cardiodiagnostic, but had been listed as the supervising physician in order for Cardiodiagnostic to be paid. On February 17, 2005, the company was ordered to pay restitution to Medicare in the amount of $55,028.31 and $2,449.28 to Medicaid. One owner was placed on 3 years probation, ordered to perform 25 hours of community service and ordered to pay restitution in the amount of $2,438.40 to Medicare. The other owner was sentenced to 3 years probation, 6 months house arrest, 25 hours of community service, and ordered to pay restitution in the amount of $52,589.91 to Medicare, and $2,499.28 to Medicaid. A Columbus, Ohio licensed practical nurse (LPN) worked as an independent provider providing skilled nursing visits and daily living services to three Medicaid recipients. An investigation, including video surveillance, uncovered that she was billing for services she did not provide, and she forged time sheets with her client's signature and submitted them for payment. After a jury trial, the LPN was found guilty of 3 counts of Medicaid Fraud and one count of Forgery. She was sentenced to 3 years community control, $1000.00 fine, $20,564.70 restitution and $15,814.14 investigative costs. The MFCU determined Ohio’s share of the Warner-Lambert national settlement to be $8 million. The Warner-Lambert settlement was to recover damages to the States’ Medicaid programs resulting from the improper marketing of the drug Neurontin. The FDA had approved the drug for the treatment of epilepsy. However, in violation of law, Warner-Lambert started marketing the drug to physicians for off-label uses where medical efficacy had not been established by the FDA. In fact, it was estimated that 90% of the current usage was for non-approved purposes. Warner-Lambert made this scheme possible by sponsoring medical education programs for physicians (that could be

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characterized as no more than expensive perks), and providing misleading information regarding Neurontin’s off-label efficacy. Moreover, Warner-Lambert provided improper “research payments” which were actually kickbacks to physicians who frequently prescribed the drug for off-label uses. As a result, Warner-Lambert pled guilty to violating the Food, Drug, and Cosmetics act and paid a fine of $240 million. In addition, Warner-Lambert entered into a civil settlement with the United States to pay $152 million of which Ohio’s combined federal/state share was $8 million. Lastly, WarnerLambert agreed to settle consumer protection claims with the States for an additional $38 million. Ohio received $4 million (combined federal/state share) of a national settlement entered into with Serono to recover damages to the States’ Medicaid programs resulting from the improper marketing of the drug Serostim. Serostim is approved by the FDA for the treatment of AIDS wasting. However, Serono knowingly promoted the sale and use of Serostim for body cell mass wasting, and off-label uses for which the FDA has not approved the drug. Thus, Serono caused false and/or fraudulent claims to be submitted to Medicaid for Serostim that had been dispensed to patients with those conditions. Furthermore, in an effort to increase the number of prescriptions written, Serono introduced non-FDA approved computer software devices into the market to support Serostim prescriptions (resulting in many “false positives”) as well as provided physicians and pharmacies with various illegal kickbacks and remuneration in violation of Federal and State law. In addition to a criminal fine of $150 million, the civil settlement required Serono to pay $567 million for Medicaid program damages. Patient Abuse Cases What is Patient Abuse? Under ORC 2903.34, patient abuse occurs when a care facility employee knowingly causes physical harm or recklessly causes serious physical harm by physical contact with the person or by the inappropriate use of physical or chemical restraints, medication or isolation of the person. What is Patient Neglect? Patient Neglect occurs when an employee of a care facility knowingly causes physical harm or recklessly causes serious physical harm by failing to provide a person with any treatment, care goods or services that is necessary to maintain the health or safety of the person. The following are some patient abuse and neglect cases prosecuted in 2005: On the morning of September 12, 2004, a resident of a Van Wert county nursing home was found in her bed with a bloody, discolored and swollen lip. The elderly, female resident, who suffers from dementia, was unable to relate how this occurred. The person caring for her during the night was a male state tested nursing assistant (STNA) who

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denied that he had struck the resident, maintaining that she had probably hit herself. During the course of the investigation, the STNA was interviewed by state investigators and admitted the resident had not hit herself, and, in fact, he had struck her. The STNA claimed the resident had become combative, swinging her arms and hitting him. He admitted that he struck back in anger, punching the elderly resident in the mouth causing it to bleed and swell. According to the STNA, he punched the resident in the mouth with a closed fist. He additionally acknowledged, “I hit her good.” The STNA was indicted by a Van Wert County Grand Jury on 1 count of patient abuse as defined in O.R.C. 2903.34. He pled to a felony charge of patient abuse and was sentenced to 30 days incarceration, 60 days house arrest, 5 years of community control (probation), and 500 hours of community service. In a Medina County nursing home, a Licensed Practical Nurse (LPN) and a State Tested Nursing Assistant (STNA) were engaged in a constant feud with employees who worked on opposing shifts. In an effort to cause more work and inconvenience for other employees at the facility, the nurse, with the aide’s assistance, administered laxatives to numerous residents at the facility. They did this knowing the residents would suffer from diarrhea, which would then cause a mess for the next-shift employees. Both the LPN and the STNA were interviewed by state investigators, and they eventually confessed to their actions. They were both indicted by a Medina County Grand Jury on 5 counts (each) of patient abuse, a felony, and they later pled to those charges. Both received a sentence of 10 months incarceration and the LPN lost her license to practice nursing in Ohio. In a Cuyahoga County nursing home, an elderly resident, who was resisting care from the STNA assigned to her, was pinned down in her bed and punched on the right side of her face. The punch from the STNA caused bruising and swelling to the resident’s right cheek, eye and bridge of her nose. Agents from this office investigated and verified through witness testimony that the punch to the resident was in retaliation for the resident’s resistance to care. Although aware there was an eyewitness to this event, the STNA denied the incident occurred. The STNA was indicted by a Cuyahoga County Grand Jury for 1 count of patient abuse. Her charge was later pled down to 1 count of assault, a misdemeanor, and the STNA was sentenced to 40 hours of community service. In a Brown County nursing home, a male STNA was seen standing over an elderly female resident’s bed with his pants pulled down exposing his genitals. Upon investigation, it was learned that the same STNA had possibly exposed himself to a comatose male resident at the same facility. In interviews with a MFCU Agent, the STNA admitted that he had exposed himself to the female resident just to see her reaction and to the male resident just to see what it would feel like. The STNA was charged with 2 counts of public indecency and later pled to 1 count of public indecency. He was sentenced to 1 year of probation and was prohibited from working in any care facility. In a Stark County nursing home, an 81 year old female resident who suffered from osteoporosis and pneumonia and who was classified as an “extensive care” resident,

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was left unattended on a commode for an extended period of time. The STNA who was assigned to her care was aware of her care requirements, however, knowingly left her unattended for an extended period of time. This resulted in the resident falling to the floor causing fractures to 2 ribs and to her lower lumbar spine. Upon investigation by a Special Agent, the STNA admitted she left the resident alone and, then, upon discovery of the resident’s fall, she failed to report the incident. The failure to report caused the resident to endure pain for an extended period of time before her injuries were detected. The STNA was charged with one count of patient neglect. She was found guilty of neglecting the resident and was sentenced to 10 days incarceration (which was suspended) and 10 days of community service. Misappropriation Case The Business Office Manager at the Edgewood Manor Nursing Home was discovered to have taken money from the resident trust account and used it for her own use. The Manager admitted to the Port Clinton Police Department that she forged the name of another employee in order to cash 79 checks for her own use. An MFCU Agent, working with a local detective, reviewed nursing home transactions, the Manager’s personal accounts and other documents and determined that $64,014.92 had been stolen. The case was referred to the Ottawa County Prosecutor for prosecution. The Manager pled guilty to theft and was sentenced to pay restitution of the $64,014.92 and was given 3 years probation and 100 hours of community service.

Workers’ Compensation Fraud Unit In 2005, the WCFU received 143 cases, indicted 123 cases, obtained 126 convictions and helped BWC obtain nearly $1.23 million in restitution. The following are some cases the Unit prosecuted during the last year: Workers’ Compensation Fraud Cases In April 2001, a Newark, Ohio man claimed to have suffered an industrial injury while working at Martinbird Enterprises. BWC awarded him temporary total disability and paid him living maintenance benefits and his rehabilitation costs. In late August 2001, Martinbird Enterprises notified BWC that the man was working for an unknown real estate agency in Newark. The investigation found the man worked full time and earned $14,512 in real estate commissions while he was on temporary total disability benefits. On March 7, 2005, a jury returned a guilty verdict against the Newark man for one count of Workers’ Compensation fraud. The court imposed five years of community control and ordered the man to pay restitution in the amount of $24,999.28 to the Bureau of Workers’ Compensation. The man was also ordered to pay court costs and fees for the probation department’s supervision. 10

After allegedly sustaining a work-related injury to his back, a Richland County man filed a request for temporary total disability benefits (TTD) with the Ohio Bureau of Workers’ Compensation (BWC). He was awarded TTD benefits. Less than a month later, posing as his cousin (without the cousin’s permission), he allegedly sustained another work-related injury and was awarded benefits under this claim. He was also receiving prescription pain medication under both claims. Unbeknownst to him, the Pharmacist who had filled his initial prescription, relocated to a new Pharmacy, which was where he chose to fill the second prescription. Posing as his cousin, the Pharmacist recognized him and this led to his arrest by Richland County detectives for deception to obtain dangerous drugs. At the arraignment, the Judge recognized his real name. The defendant failed to show for his hearing and the Richland County Municipal Court declared him an absconder and issued a bench warrant for his arrest. The perpetrator posed as various people and received workers’ compensation in several states until arrested in Chicago, Illinois, for defrauding an insurance company. The Defendant was extradited back to Franklin County, Ohio, where he pled guilty to one count of Workers’ Compensation Fraud, a fourth degree felony, and was sentenced to fourteen months in prison and ordered to pay restitution in the amount of $98,511.31. The owner of Mueller Tree Service operated his business without workers’ compensation coverage and altered BWC coverage certificates to reflect that he had current coverage. He then uttered the altered certificates to several prospective customers, including a BWC special agent during an undercover. Special agents obtained several copies of altered BWC certificates from a search of Mueller’s business office and from various witnesses. Mueller was convicted of one count of tampering with records, a felony and one count of failure to comply, a misdemeanor and given two years of community control.

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Conclusion Fraud against State assistance programs steals money from the taxpayers’ pockets. Abuse and neglect of our loved ones in nursing homes hurts families and can destroy lives. The Health Care Fraud Section is on the front line of the battle to end these crimes. But, we cannot do it alone. Our success comes from the Ohioans who decide to take a stand and report these crimes when they see them occur. So, join the fight and report suspected fraud or abuse by contacting Attorney General Jim Petro’s Health Care Fraud Section. In Writing: 150 East Gay St. 17th Floor Columbus, OH 43215 By Telephone: (800) 64-ABUSE or 1-800-642-2873 Online: http://www.ag.state.oh.us

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ATTACHMENT

A

KEY LEGISLATION RELATED TO THE HEALTH CARE FRAUD SECTION 1965

Title XIX of the Social Security Act created the Medicaid program. It provides for State administered and federally monitored financing of medical service for low income individuals, the disabled and elderly. In addition, the program established linkage between Medicaid eligibility and receipt of Aid to Families with Dependent Children (AFDC) cash assistance.

1976

The Office of the Inspector General (OIG) was established. The mission of the Department of Health and Human Services OIG was to protect the integrity of the department’s programs and provide oversight of the MFCUs.

1977

On October 25, 1977, the President signed into law the Medicare and Medicaid Anti-Fraud and Abuse Amendments, Public Law 95-142 which among other things authorized the establishment of, and Federal funding for, the State Medicaid Fraud Control Units for a three year period.

1978

Ohio Revised Code 109.85 was codified authorizing the Ohio Attorney General to create the Medicaid Fraud Control Unit (MFCU). MFCU is authorized to investigate and prosecute Medicaid Fraud, including Theft and Misappropriation of Funds in a nursing care facility under Section 3721.

1981

The Omnibus Reconciliation Act of 1980, Public Law 96-499, provided permanent Federal funding for the State MFCUs beyond the 3-year period. This law made Federal grant funds available at a rate of 90 percent for the first 3 years of the MFCU’s operation and 75 percent thereafter.

1983

The Omnibus Budget Reconciliation Act of 1983, Section 13625, required the Office of the Inspector General for HHS to develop 12 performance standards for assessing the MFCUs. These standards are still used by OIG to assess the effectiveness and efficiency of MFCUs.

1986

On September 17, 1986, the Legislature passed 2903.34 (HB 566) which states: (A) No person who owns, operates, or administers, or who is an agent or employee of, a care facility shall do any of the following: (1) Commit abuse against a resident or patient of the facility; (2) Commit gross neglect against a resident or patient of the facility; (3) Commit neglect against a resident or patient of the facility.

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ORC 109.86 says the attorney general shall investigate and prosecute any activity, including patient abuse and neglect in a health care facility, the attorney general has reasonable cause to believe is in violation of section 2903.34 of the Revised Code. 1995

Section 3721.22 requires a licensed health care professional in a residential care facility to report abuse, neglect or misappropriation of property to the director of health. If the director of health believes abuse, neglect or misappropriation of property has occurred, the director may report the incident to the Ohio Attorney General's Office.

1999

On December 16, 1999, the President signed into law the ticket to Work And Work Incentives Improvement Act of 1999, Public Law 106-170, allowing MFCUs to investigate and prosecute patient abuse or neglect committed against individuals in non-Medicaid assisted living or “board and care” facilities.

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Attachment B MEDICAID FRAUD CONTROL UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Provider Type

County

Offense

Adrienne Foster

Independent home health provider

Franklin

Medicaid Fraud

Pamela Laury

Mother of recipient

Franklin

Medicaid Fraud

Erica McElroy

Michelle Smith

Inn at Lakeview

Manor Care of Lakeshore

William Springhart

Sandra Teapole

McCrea Manor Nursing & Rehab. Center

Edgewood Manor Nursing Home

Credit Card Theft

Employee of facility Cuyahoga

Father of recipient

Cardiodiagnostic Services

Jeri Chini

Employee of facility Franklin

Franklin

Allegation

Billing for services not rendered

Filled out false claims Stole & used resident credit card

Theft, Credit Card Misuse & Forgery

Stole & Used resident ATM card

Medicaid Fraud

Hired Independent Provider & Instructed to bill for services not rendered Left resident unattended on the toilet and she fell off sustaining fractured ribs and lower spine

Restitution Ordered

$708.00 6 months probation 5 yrs. probation, & 500 $3,000.00 hrs. community service 2 years community control $ 410.27 - to be paid jointly with co-defendant 1 year probation

$1,200.00

Nurse aide

Stark

Patient Neglect

Diagnostic Lab

Franklin

Making a False Statement

$55,028.31 (Medicare) $2,449.28 (Medicaid) joint and several Billed for services not liability w/R. rendered Jones

Theft

Stole money from nursing home resident trust accounts and forged signatures on checks

Office Business Manager

Ottawa 15

Sentence

10 days jail & 10 days community service

5 years probation

3 years probation & 100 $64,014.92 hrs. community service

Attachment B MEDICAID FRAUD CONTROL UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Connie Jones

Employer

Cardiodiagnostic Services

Richard Jones

Cardiodiagnostic Services

Lionel Bertie

Sunbridge Care & Rehabilitation

Kim Moenich

Lori Levy Madolyn Gilles

Vice-president and co-owner

President and coowner

Activity Assistant

County

Making a False Statement Relating to a Health Care Matter

Allegation

Restitution Ordered

Franklin

Making a False Statement

Billed for services not $2,438.40 rendered Medicare $2,499.28 Medicaid, $52,589.91 Medicare/joint and several Billed for services not liability with rendered corp.

Lucas

Theft from the Elderly

Forged receipt claims against patient fund accounts.

Patient Abuse

Administered laxatives to patients in order to make things difficult for the day shift

L.P.N.

Wexner Heritage Village

Part-owner of company Franklin Employee of nursing home Franklin

New Dimensions, Inc. Business owner Bradley Road Nursing Home L.P.N.

Offense

Franklin

Willowood Care Center of Brunswick

Brian Hathaway Gracie Wellman

Provider Type

Medina

Medicaid Fraud Theft

Franklin

Medicaid Fraud

Cuyahoga

Assault

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Billing for fictitious ambulette runs Stole money from a resident's room Billing for services not rendered Struck resident with her fist

Sentence

3 years probation & 25 hours community service

3 years probation, 6 months house arrest, 25 hours community service

1 year in prison

10 months in prison 5 years community control & 100 hrs. $142,881.90 community service

5 years community control, 50 hours $95,000.00 community service 40 hours com-munity service

Attachment B MEDICAID FRAUD CONTROL UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Provider Type

County

Lawrence Weekes

Isabelle Ridgeway Center

Jeffrey Bates

Golden Age Mobility Partner in business

Trumbull

Jonathan Crutchfield

Community Support

Hamilton

Cheryl Denney

Ramie Haddad

Home health aide

R.N.

Lora Gregory

Charlie Haddad

Nurse aide

L.P.N.

CVS Pharmacy

CVS Pharmacy

Pharmacy tech

None

Offense

Allegation

Nurse aide failed to place required mat Failure to Provide beside bed and Care to a resident fell sustained Functionally a laceration on his Impaired Person forehead Billing for services Medicaid Fraud not rendered Lied on job application about his felony record & billed for services not Medicaid Fraud provided Billed for skilled nursing and daily living services not Medicaid Fraud rendered. Billing Medicaid for services while having Unlicensed Practice an expired nursing of Nursing license

Franklin

Franklin

Franklin

Drug trafficking & Tampering with Records

Cuyahoga

Cuyahoga

Drug Possession

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Filled pre-scriptions and billed Medicaid using a recipient's name, then gave prescriptions to his brother Brother filled prescriptions and billed Medicaid using a recipient's name then they were given to him

Restitution Ordered

Sentence

1 year probation, 40 hours community service & court costs 3 years community $30,335.37 control

$6,500.00 7 months prison 11 months prison, suspended, 5 years $54,480.00 community control Ordered to pay restitution by November $1,564.80 10, 2005

3 years com-munity control, 200 hours community service

3 years com-munity control, 200 hours community service

Attachment B MEDICAID FRAUD CONTROL UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Provider Type

County

Offense

Allegation

Stole check from resident's room and deposited it into her bank account

Restitution Ordered

Sentence

10 months jail suspended, 6 months "home incarceration" at a halfway house, 2 years community control

Cherise Haynes

Valley View Nursing Nurse aide

Summit

Michelle Hunter

Guardian Health Services

Business Owner

Cuyahoga

Theft from the Elderly Bank Fraud & Making a False Statement

Johnna Koch

Home health aide

Franklin

Medicaid Fraud

Billing for services not rendered Billing for services not rendered

Tawanda Laws

Independent home health provider

Franklin

Medicaid Fraud

Billing for services not rendered

Patient Abuse

Punched resident in the mouth

Patient Abuse

Grabbed and twisted resident arm leaving hand-print bruises

1 year jail suspended, 5 years probation & cannot work in nursing

Patient Abuse

Hit one resident and picked up another resident and dropped him into his bed

Six months suspended, 2 years community control & 40 hrs. community service

Patient Neglect

Threw resident into a wheelchair forcefully and caused a 3-4" scratch on her arm

60 days jail suspended, 2 years probation, surrender nursing license

Chad Clay

Anita Howe

Van Wert Manor

Carlton Manor

Weldon Smoot

Shari Boric

Nurse aide

Nurse aide

Nurse aide

Mercy Franciscan

L.P.N.

Van Wert

Fayette

Fayette

Butler

18

37 months in federal $32,951.70 prison 3 years community $13,071.00 control 6 months, suspended, 3 $804.00 years probation 30 days jail, 60 days house arrest, 5 years community control & 500 hrs.community service

Attachment B MEDICAID FRAUD CONTROL UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Jennifer Stetka

Employer

Stetka Prescriptions

Provider Type

Natalie Mauldin, L.P.N.

Allegation

Forged prescriptions for Oxycontin and filled them using Medicaid cards

Medicaid Fraud

Billing for services not rendered

Franklin

Medicaid Fraud

Billed for services not rendered and manipulated claims resulting in a higher reimbursement rate

None

Franklin

Sold physician drugs Sale of Unapproved which were not yet Drugs FDA approved.

None

Home health nurse

Robert Koehler

Offense

Illegal Processing of Drug Docu-ments, Attempted Possession of Drugs

Independent home health provider

Hetty Cruz

County

Geauga

Franklin

Restitution Ordered

Sentence

12 months in jail, 5 years community control 30 days jail, 3 years community control, drug $26,188.50 and alcohol screenings

180 days jail suspended, $1,537.00 1 year probation

6 months, suspended, 2 years probation

Dorothy Austin

Shawnee Manor

Nurse aide

Allen

Persistent Struck resident in the Disorderly Conduct chest

Anita Craig

O'Brien Memorial Health Center

Nurse Aide

Trumbull

Assault

Independent home health provider

Franklin

L.P.N.

Franklin

Medicaid Fraud Forgery, Medicaid Fraud

Lucas

Health Care Fraud, Provided used $58,200.00 (HCF), Bankruptcy Fraud wheelchairs but billed $79,022.00 (TE), 51 months in prison, 3 and Tax Evasion for new wheelchairs $14,736.00 (BF) years supervised release

Debbie C. Belle Sheila Breckenridge, L.P.N.

Michael Frantz

Medi Care Orthopedic Business owner

19

Forcefully struck a resident in the head Billing for services to family member, making false and misleading statements Billing for services not provided

30 days, suspended 6 months in jail, suspended, 2 years probation

5 years supervision, pay $50,497.50 cost of supervision 3 years com-munity $20,564.70 control

Attachment B MEDICAID FRAUD CONTROL UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Jan Halicki

James Sutton

Home health aide

Skill Care Transportation

Beth Forward

Business owner

Mother of recipient

Rajiv Taneja, D.M.D.

Lavenna Todd

Provider Type

Dentist

Renaissance Retirement

Nurse aide

County

Offense

Allegation

Restitution Ordered

Sentence

Medicaid Fraud

Billing for services not rendered

Medicaid Fraud

Billing for transports of ambulatory individuals

5 years com-munity control, 4 years $132,838.67 suspended

Medicaid Fraud

Accepted kickbacks for services not rendered and caused false billings to be submitted

5 years com-munity $67,854.50 control

Franklin

Medicaid Fraud

Billed both Medicaid and private insurers and kept money from both

$12,500.00

Cuyahoga

Theft, Aggravated Theft with Elderly Spec, Forgery with Elderly Spec

Franklin

Franklin

Franklin

Raymond Crabtree

Carlton Manor

Nurse aide

Fayette

Patient Abuse

Sue Mejak

Willowood Care Center

Nurse aide

Medina

Patient Abuse

20

Stole checks from resident

Slapped resident across the face LPN gave laxative to patients to create difficulties for the day shift

$18,500.00 3 years probation

3 years community control, 200 hrs. community service, drug testing, attend AA mtgs., drug $700.00 treatment 6 months prison, 3 yrs. community control, 40 hrs. community service, surrender nurse aide license

10 months in prison

Attachment B MEDICAID FRAUD CONTROL UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Darnell Sims

Employer

Manor Care Health Services

Provider Type

Nurse aide

County

Offense

Assault, Patient Abuse

Cuyahoga

Allegation

Zebulun Balas

Recipient

Wayne

Joseph R. Evans

Home health aide

Franklin

Melanie Wallerick

Independent home health provider

Franklin

Medicaid Fraud

Billing for services not rendered

Angeline Jamar

Nelson Park Care Center

Nurse aide

Franklin

Patient Neglect

Cheryl Thompson

Arlington Nursing Home

Nurse aide

Franklin

Assault

Afrique Wallace

Somerset Point

Nurse aide

Cuyahoga

Patient Abuse

James Wuellah

Bryden Place

Nurse aide

Franklin

Patient Neglect

Debbie Fleming

Home health aide

Franklin

Medicaid Fraud

Punched a resident in the jaw Hit resident on the left side of his face with an open hand Billing for services not rendered

Edward Seleznyov

Co-owner of business

Health Care Fraud

Transportation of ambulatory individuals

21

Struck resident in the chest repeatedly Struck resident's cheek with the palm of her hand

Sentence 3 years community control, drug testing, no employment in health care facility, court costs, probation supervision costs

Slapped resident on the face and hand

Stole prescriptions Medicaid Fraud, from his doctor and Illegal Processing of had them filled using Drug Documents, his Medicaid card Billing for services Medicaid Fraud not rendered

Cuyahoga

Restitution Ordered

2 years probation $12,000.00

$16,667.00 6 months jail, suspended 10 days in jail, suspended, 6 months probation 6 months probation, court costs 6 months suspended, 2 years community control, 100 hours community service

1 year probation 6 months suspended, 5 $4,824.00 years probation 6 months house arrest, $120,000.00 100 hours community (jointly w/coservice, 3 years defendants) probation

Attachment B MEDICAID FRAUD CONTROL UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Sherry Stenger Carl Roehm

Meadow Wood Care Center

Provider Type

County

Home health aide

Franklin

Nurse aide

Brown

Offense

Allegation

$2,664.00 1 year probation 90 days jail, suspended if fine and restitution are $2,036.40 paid by 12/292/06

$6,170.00 10 months in jail

Phyllis Edwards

Indepen-dent home health provider Franklin

Medicaid Fraud

Billing for services not rendered

Medicaid recipient

Deception to Obtain Drugs, Deception to Obtain Drugs, Medicaid Fraud

Used false prescriptions to obtain drugs using his Medicaid number

Health Care Fraud

Billing for the transportation of ambulatory patients

Health Care Fraud

Billing for services not rendered

Health Care Fraud

Transportation of ambulatory individuals

Boris Malahimov

Concord Transportation, Inc.

Owner of business

Igor Murin

Contact Express International

Co-owner of business

Lev Musaelyants

Co-owner of Lana's Transportation business

Cuyahoga

Cuyahoga

Cuyahoga

22

6 months suspended on condition of no new convictions for 2 years, court $972.00 costs

Theft

Indepen-dent home health provider Franklin

Hardin

Sentence

Billing for services not rendered Exposed penis to resident Billed for home health services not provided, hired someone who is not a provider to work in her place

Medicaid Fraud Public Indecency (misdemeanor)

Sherry Clark

Brent Keim

Restitution Ordered

1 year probation

18 months in prison, 2 $120,001.00 years super-vised release $400,000.00 (joint with co8 months in prison, 2 defendants) years pro-bation 6 months in prison, 6 months home confinement (w/electronic $120,000.00 (joint monitoring), 3 years w/co-defendants) probation

Attachment B MEDICAID FRAUD CONTROL UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Provider Type

County

Offense

Allegation

Transportation of ambulatory individuals

Paul Musaelyants

Co-owner of Lana's Transportation business

Cuyahoga

Health Care Fraud

Mikhail Rustamov

Contact Express International

Co-owner of business

Cuyahoga

Conspiracy, Health Billing for services Care Fraud not rendered

Emil Shnartsman

Contact Express International

Co-owner of business

Cuyahoga

Health Care Fraud

L.P.N.

Franklin

Medicaid Fraud

Katrina Harris

Shirelle McClure

L.P.N.

Franklin

Medicaid Fraud

Billing for services not rendered Billing for services not rendered

Billing for services not rendered

Business owner

Franklin

Health Care Fraud

Yuriy Romanov

Sun Arrow, Inc. Contact Express International

Business owner

Franklin

Jean Mitchell

Pleasant Care Center

Nurse aide

Summit

Health Care Fraud Witness Intimidation

Transporting and billing for patients that are ambulatory Billing for services not rendered Stomped on resident's hand

Home health aide

Franklin

Medicaid Fraud

Billing for services not rendered

Mikhail Perkis

Jennifer Baker

23

Restitution Ordered

Sentence

3 years pro-bation with 6 months home $30,000.00 (joint confinement (electronic w/co-defendants) monitoring) $400,000.00 (joint 20 months in prison, 2 w/co-defendants) years probation $120,000.00 (joint 8 months in prison, 2 w/co-defendants) years supervised release $664.60 90 days jail suspended, 180 days community control during which time she is to make full $3,181.40 restitution 3 years pro-bation, 6 months home confinement $120,000.00 w/electronic monitoring $200,000.00 8 months in prison 2 years community control 1 year community control, basic supervision, costs of prosecution & supervision, 40 hours $6,100.00 community service

Attachment B MEDICAID FRAUD CONTROL UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Daisy Washington

Shirelle McClure

Employer

Pleasant Care Center

Provider Type

Employee

Home health nurse

County

Offense

Cuyahoga

Franklin

24

Allegation

Tampering with Evidence, Theft w/Elderly Spec

Stole cash from resident

Medicaid Fraud

Billing for services not rendered

Restitution Ordered

Sentence

5 years community control, 200 hours community service, alcohol and drug testing, restitution, supervision $360.00 fee 90 days jail suspended, 180 days community $3,181.40 control, and court costs

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Breininger, Robert

Nicolette, Ray

Type

Claimant Empire Environmental

Pascoe, Charlotte

Employer

Claimant

Cole, Calvin Sr.

County

Offense

Allegation

Restitution Ordered

Sentence

Lucas

Falsification

Falsification

Capias

Columbiana

Failure to Comply

Failure to Pay BWC Premiums

Franklin

Workers' Compensation Fraud

Working While Receiving

5 Years Community Control $12,730.19 and Restitution

12 Months Incarceration, $24,555.00 Court Costs and Restitution

30 Days Suspended for 1 Year Probation and Fine $0.00 $500

Claimant

Mahoning

Theft

Forged his dead mother's signature and cashed widow benefit warrants.

Employer

Lucas

Failure to Comply

Failure to Pay BWC Premiums

Fine, Costs $57.00, Sheriff $0.00 Fees $18.00

Failure to Pay BWC Premiums

30 Days Suspended for 2 Years Probation, Fine $150 $0.00 and Court Costs

Helberg, Richard

Tower Building Services

Dennison, Leonard

Speciality Pie Bakers

Employer

Knox

Failure to Comply

Pignotti, Michael

Basil's Café

Employer

Ashtabula

Failure to Comply

Failure to Pay BWC Premiums

$0.00 Fine

Pignotti, Michael

Basil's Café

Employer

Ashtabula

Failure to Comply

Failure to Pay BWC Premiums

$0.00 Fine

25

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Type

County

Offense

Allegation

Cuyahoga

Illegal Processing of Drug Docs, Workers' Compensation Fraud, Tampering w/Records

Engaging in a Pattern of Corrupt Activity

Failure to Pay BWC Premiums

Restitution Ordered

Sentence

Fine $2,000, Court Costs, 3 Years Probation, 300 Hours $0.00 Community Work Service

Weaver, Carla

Westside Medical Provider

Griffith, Adam

Infinet Training & Technologies Employer

Coshocton

Failure to Comply

Flake, William

WE Products, Inc. Employer

Guernsey

Failure to Comply

Failure to Pay BWC Premiums

$0.00 Fine & Costs

Straker, Joel

Straker Trucking Employer

Logan

Failure to Comply

Failure to Pay BWC Premiums

Fine $100 and Court Costs $0.00 $77

Thompson, Todd

Spring Valley Development Inc. Employer

Greene

Failure to Comply

Failure to Pay BWC Premiums

Shuster, Todd

Erickson's Family Restaurant Employer

Wood

Failure to Comply

Failure to Pay BWC Premiums

90 Days Suspended, 5 Years $0.00 Probation

Failure to Pay BWC Premiums

Fine, 30 Days Suspended, 1 Year Probation - Condition: Pay Employer Premiums $104,005.40 Due

Cooper, Raymond

Pataskala Paving Claimant

Franklin

Failure to Comply

26

30 Days Jail Time Suspended, Fine and $327.97 Restitution

90 Days Jail Suspended, Court Costs $95 and $31,024.54 Restitution

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Arreguin, Salvador

Miller, Kenneth

Siverre Inc.

JIT Pallets

Lowe, Shirlene

Stuble, Karl H.

303 Sand & Gravel

Offense

Allegation

Restitution Ordered

Sentence

6 Months Jail, w/90 Days Suspended, 91 Days Jail Time Credit, 2 Years Community Control (1 Yr. Reporting/1 Yr. NonReporting), Court Costs and $15,026.00 Restitution

Franklin

False Claim; Falsification

Franklin

Workers' Compensation Fraud

Forged and cashed deceased claimant's BWC checks.

1 Year Community Control $947.90 and Restitution

Claimant

Franklin

Workers' Compensation Fraud

Working While Receiving

5 Years Community Control $29,032.24 and Restitution

Employer

Muskingum

Failure to Comply

Failure to Pay BWC Premiums

Claimant

Goodroe, Charles

County

Workers' Compensation Fraud

Claimant

Berry, Mozelle T.

Nolan, George S.

Type

Columbiana

Failure to Comply

Failure to Pay BWC Premiums

Claimant

Franklin

Attempted Workers' Compensation Fraud

Working While Receiving

Employer

Portage

Failure to Comply

Failure to Pay BWC Premiums

Employer

27

Fine and 12 Months $0.00 Probation

90 Days Suspended for 2 Years Probation, 80 Hours Community Service, $47,698.97 Restitution and Fine

1 Year Probation and $3,000.00 Restitution Jail Time Suspended and $0.00 Court Costs $62

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

May, William Jr.

Claimant

Hileman, Robert

Appis, Travis P.

Claimant

Spitler's Family Restaurant

Crawford, Bryan Sulzer, Louis Jr.

Hall, Lowell

Ferenz, Gerhard F.

Scherkoske, Sharon

Type

CAI Trucking

County

Offense

Franklin

Workers' Compensation Fraud

Franklin

Workers' Compensation Fraud

Allegation

6 Months Incarceration Suspended for 5 Years $6,285.39 Probation and Restitution

Working While Receiving

6 Months Suspended for 5 Years Probation, Restitution, Court Costs, Investigative $7,000.00 Costs

Failure to Comply

Failure to Pay BWC Premiums

Claimant

Franklin

Workers' Compensation Fraud

Working While Receiving

Employer

Cuyahoga

Failure to Comply

Failure to Pay BWC Premiums

Franklin

Workers' Compensation Fraud

Working While Receiving

Franklin

Workers' Compensation Fraud

Working While Receiving

Lucas

Failure to Comply

Failure to Pay BWC Premiums

Claimant

Claimant

Tana Corporation Employer

28

Sentence

Working While Receiving

Coshocton

Employer

Restitution Ordered

Fine $100.00 Suspended, 60 Days Jail Sentence Suspended and 80 Hours $0.00 Community Service

30 Days Suspended, Fine $2,781.16 Court Costs and Restitution $0.00 Fine and Costs Fine, Court Costs and $11,685.75 Restitution

5 Years Community Control, $5,941.41 Fine and Restitution

$0.00 Court Costs $79.00 and Fine

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Guilfoil, Stephen

Type

County

Offense

Claimant

Franklin

Workers' Compensation Fraud

Allegation

Restitution Ordered

Sentence

Working While Receiving

14 Months Incarceration (6 Mon. Served w/8 Mo. Left $98,511.31 to serve) and Restitution

Mullen, William

Xpress Print Inc.

Employer

Stark

Failure to Comply

Failure to Pay BWC Premiums

$0.00 Fine and Court Costs

Mullen, William

Xpress Print Inc.

Employer

Hancock

Failure to Comply

Failure to Pay BWC Premiums

30 Days Suspended, Fine $0.00 and Court Costs

Moore, Corbin

Olasky, Joseph

Hotzler, Barry

Queen, Gary L.

Torok, Mark

Westside Medical Provider

Claimant

Claimant

Claimant

Claimant

Cuyahoga

Failure to Report Felony

Obstructing Justice

Franklin

Workers' Compensation Fraud

Working While Receiving

Franklin

Workers' Compensation Fraud

Working While Receiving

4 Months Suspended Incarceration for 2 Years Community Control and $1,720.00 Restitution

Franklin

Workers' Compensation Fraud

Working While Receiving

Fine, Court Costs, 12 Months Non-Reporting $2,870.81 Probation

Franklin

Workers' Compensation Fraud

Working While Receiving

$4,121.77 6 Days Jail Time

29

$4,000.00 Forfeiture

Fine, Court Costs, 30 Days Suspended for 6 Months Probation and $15,000.00 Forfeiture

10 Months Prison, Restitution and Court Costs $20,608.85 $273.10

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Lee, Marie

Wright, Marty

Mozzochi, Barbara E.

Banks, Wendy L.

Buck, Richard

Dillon, Ronald

Employer

Type

Claimant

Claimant Blockbuster Construction LTD Employer Delaware Maintenance Company Employer

Claimant

Claimant

County

Offense

Allegation

Restitution Ordered

Sentence

180 Days Incarceration Suspended for 1 Year Probation, Court Costs and $724.86 Restitution

Workers' Compensation Fraud

Working While Receiving

Franklin

Workers' Compensation Fraud

Working while receiving and failure to notify the BWC of claimant's receipt of unemployment benefits.

Columbiana

Failure to Comply

Failure to Pay BWC Premiums

$0.00 Fine

Delaware

Failure to Comply

Failure to Pay BWC Premiums

$0.00 Fine and court Costs

Franklin

Workers' Compensation Fraud

Working While Receiving

6 Months Suspended for 3 Years Probation, Fine, Court $4,178.00 Costs and Restitution

Franklin

Workers' Compensation Fraud

Working While Receiving

5 Years Community Control, Court Costs, $60.00 Supervision Fee and $24,999.28 Restitution

Franklin

30

180 Days Suspended, 2 Years Probation, Fine and $5,826.85 Investigative Costs

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Type

County

Lover, Thomas Scott DC

Westside Medical Provider

Cuyahoga

Schroll, Sanford

American Scrap Tire Recyclers dba Perfect Mulch Employer

Ashtabula

Fejes, Michael

Claimant

Franklin

Bugala, Michael A.

Claimant

Franklin

Stumpff, James E.

Bailey, Michael

Bailey's Café

Offense

Allegation

Workers' Compensation Fraud, Engaging in a Pattern of Corrupt Activity, Conspiracy to Commit Felony Drug Trafficking, Theft, Identity Fraud, Tampering with Records and Drug Trafficking, Money Services Not Laundering Rendered

Failure to Comply Workers' Compensation Fraud Workers' Compensation Fraud

Failure to Pay BWC Premiums Working While Receiving Working While Receiving

Claimant

Montgomery

Falsification

Attempted Workers' Compensation Fraud (M1)

Employer

Guernsey

Failure to Comply

Failure to Pay BWC Premiums

31

Restitution Ordered

Sentence

Forfeit Bank Account - 3 Years Incarceration and $191,000.00 Restitution

$0.00 Fine 6 Months Suspended for $9,994.32 Repayment of Restitution 10 Days Incarceration Suspended, Fine and Court $5,045.14 Costs 3 Months Suspended Incarceration, Fine and $0.00 Court Costs Fine $100 and Costs, 10 Days Jail Suspended, 12 Months $0.00 Supervision

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Type

County

Offense

Allegation

Restitution Ordered

Sentence

Evans, Robert F.

Claimant

Franklin

Hanks, Todd

Claimant

Franklin

Anania, Roxanne

Claimant

Franklin

Workers' Compensation Fraud Workers' Compensation Fraud Workers' Compensation Fraud

Cuyahoga

Grand Theft and 7 Other Charges SNR

Franklin

Workers' Compensation Fraud

Working While Receiving

3 Months Incarceration Suspended for 3 Years Probation, Restitution and $7,378.76 Court Costs

Workers' Compensation Fraud

Forged and cashed deceased mother's Widow Death warrants.

6 Months Incarceration Suspended, Restitution, 80 Hours Community Service $5,731.74 and Court Costs

Kinnen, Stephanie

Ward, Jacqueline

Westside Medical Provider

Claimant

Working While Receiving Working While Receiving Working While Receiving

Blake, Carol J.

Claimant

Franklin

Marston, Meadow

Claimant

Franklin

Shannon, Melissa

Claimant

Franklin

Receiving Stolen Forged a stolen Property warrant Theft of BWC Theft warrant

Franklin

Workers' Compensation Fraud

Submitted False and Misleading Job Search Forms

Cuyahoga

Workers' Compensation Fraud

Working While Receiving

Kinney, William

Allen, John

Claimant

Claimant

32

3 Years Community Control, Restitution and Investigative $2,469.71 Costs 6 Months Incarceration Suspended, Court Costs and $11,500.00 Restitution 5 Years Community Control, Investigative Costs and $12,159.48 Restitution $47,909.12 Forfeiture

2 Years Incarceration and Court Costs

30 Days Jail Suspended, $50.00 Court Costs and Restitution 5 Years Community Control $226.00 and Restitution

Abated by death. 1 Year Community Control, 80 Hrs. Community Service $33,107.15 and Fine

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Hedglin, Wayne A. II Gabel, Jack

Employer

Type

Wayne's Truck and Auto Repair Employer Gabel Masonry Inc. Employer

County

Trumbull Medina

Alphabet, Marshamelle N.

Claimant

Franklin

Smith, Joshua

Claimant

Franklin

Offense Failure to Comply Failure to Comply Workers' Compensation Fraud Workers' Compensation Fraud

Allegation Failure to Pay BWC Premiums Failure to Pay BWC Premiums

Working While Receiving

False Claim

Bayer, Dennis

Claimant

Franklin

Gibson, William

Claimant

Franklin

Monroe, Timothy

Claimant

Champaign

Workers' Compensation Fraud Workers' Compensation Fraud Failure to Comply

Erie

Attempted Workers' Compensation Fraud

Working While Receiving

Working While Receiving

False Claim

Routh, Robert C.

Claimant

Favret, Thomas W.

Claimant

Franklin

Workers' Compensation Fraud

Henricks, Richard

Claimant

Franklin

Forgery

33

Restitution Ordered

Sentence

30 Days Jail Time $0.00 Suspended and Fine $100

6 Months Jail Suspended for 4 Years Probation, 8 Days Jail Time Credit and $4,722.74 Restitution 6 Months Incarceration $0.00 Suspended and Court Costs

Working While Receiving

5 Years Community Control, $30,858.28 Court Costs and Restitution

Working While Receiving Failure to Pay BWC Premiums

5 Years Community Control $9,972.00 and Restitution

5 Years Community Control, $30,000.00 Court Costs and Restitution

$0.00 Fine $35.00 and Court Costs

3 Years Community Control, Court Costs, Restitution and $11,393.71 22 Days Jail Time Credit 6 Months Suspended, 3 Years Community Control, 27 Days Jail Time Credit and $250.00 Restitution

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Type

Bishop, Tom

Shamrock Inspection & Loss Control Employer Bishop Motor Car, Inc. Employer

Fleming, Luann

Dor Mar Heating and Air Conditioning, Inc. Employer

Devine, Jennifer

Manz, Brian J.

Vance, Larry

Johnson, George

Massey, Frank

Conti, John

Allegation

Restitution Ordered

Sentence

Licking

Failure to Pay BWC Premiums Failure to Pay BWC Premiums

Licking

Failure to Comply

Failure to Pay BWC Premiums

Franklin

Workers' Compensation Fraud

Working While Receiving

Franklin

Workers' Compensation Fraud

Working While Receiving Failure to Report Wages

Claimant

Cuyahoga

Failure to Comply

Altered BWC Certificate

Claimant

Cuyahoga

Attempted Forgery

Working While Receiving

Cuyahoga

Forgery

Allegedly withdrawing BWC funds from his deceased father's bank account.

6 Months Incarceration, $2,500 Fine, Court Costs and $12,745.00 Restitution

Franklin

Workers' Compensation Fraud

Working While Receiving

5 Years Community Control, $19,577.00 Court Costs and Restitution

Claimant

Larry Vance Co.

Offense Workers' Compensation Fraud Failure to Comply

Claimant

Norton, Dennis A.

County

Claimant

Claimant

Franklin

34

Court Costs of $267.00 and $0.00 Fine 60 Days Suspended, 1 Year $0.00 Probation and Fine

3 Years Probation, Court $666.00 Costs and Fine

$3,890.00 Court Costs appx. $200 5 Years Community Control, Restitution, 29 Days Jail $38,362.22 Time Credit Granted 90 Days Incarceration, 6 Months Suspended, Fine $0.00 and Court Costs

2 Years Community Control $3,136.27 and Restitution

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Yoder, Celia J.

Mueller, Matthew M.

Claimant

Mueller Tree Service

Young, Charles R.

Bidwell, Jim

Weems, Kenneth L.

Misc.

Claimant

Jim's Auto Service Employer

Kelly-Timmins, Tina

Cousino, Susan D.

Type

Medback Clinic

County

Offense

Allegation

Sentence

Franklin

Workers' Compensation Fraud

Working While Receiving

Summit

Tampering w/Records and Failure to Comply

Altered BWC Certificates showing he had BWC Coverage and he did not.

$0.00 2 Years Community Control

Franklin

Workers' Compensation Fraud

Working While Receiving

Court Costs, Restitution Pd. $2,662.71 Prior to Sentencing

Licking

Failure to Comply

Failure to Pay BWC Premiums

Franklin

Provider

US Dist. Ct. Conspiracy to Northern Dist. Commit Health Fraudulent Western Div. Care Fraud Billing

Franklin

Falsification

Working While Receiving

Claimant

Claimant

Restitution Ordered

Workers' Compensation Fraud and Failure to Appear

35

Working While Receiving/Failur e to Appear

$150 Fine and court Costs, Sentence Suspended $14,970.30

$0.00 1 Year Probation 30 Days Incarceration Suspended, $150 Fine & Court Costs Suspended, Restitution paid prior to $1,646.28 sentencing.

Dismissed August 4, 2005

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Piar, William C.

Santiago, Angela

Kelley, Julie A.

Fout, Aaron T.

Gurish, Mark

Thomas, Russell

Zahn, Daniel

Roman Floors

Type

County

Offense

Allegation

Restitution Ordered

Sentence

Claimant

Cuyahoga

Workers' Compensation Fraud

Claimant

Cuyahoga

Attempted Forgery

Working While Receiving

Franklin

Workers' Compensation Fraud

Working While Receiving

6 Months Suspended, 5 Years Probation, Restitution $4,104.00 to CBS Personnel Services

Franklin

Workers' Compensation Fraud

Working While Receiving

11 Months Incarceration Suspended for 2 Years Community Control and $1,382.40 Restitution

Cuyahoga

Workers' Compensation Fraud

Working While Receiving

$0.00 Fine and Court Costs

Franklin

Workers' Compensation Fraud

Working While Receiving

6 Months Incarceration Suspended, 3 Years Community Control and $55,136.99 Restitution

Cuyahoga

Attempted Forgery and Failure to Comply

Forged 2 BWC certificates of Workers' Compensation coverage.

90 Days Incarceration Suspended for payment of Court Costs and inactive $17,080.00 probation and Restitution.

Claimant

Claimant

Claimant

Claimant

Claimant

36

Working While Receiving

40 Hours Community Service, Court Costs and $28,856.37 Restitution

$0.00 Fine and court Costs

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Linger, Robert B.

Carter, Lavern

Eskins, Sandra G.

Costilla, Gilberto

Aduddell, Keith

Bozman, Emmanuel L.

Milillo, Vito

Employer

R & J Linger Markets

Type

Employer

Claimant

Claimant

Claimant

Claimant

Claimant

Claimant

County

Offense

Allegation

Restitution Ordered

Sentence

Franklin

Failure to Comply

Failure to Pay BWC Premiums

Franklin

Workers' Compensation Fraud

Working While Receiving

Franklin

Workers' Compensation Fraud

Submitted false job search form and working while receiving.

$300 Fine, Court Costs, Restitution, 120 Days, suspended if Fine, CC, $3,741.25 restitution paid by 9/15/07.

Franklin

Workers' Compensation Fraud

Working While Receiving

6 Months Incarceration and $1,184.10 Restitution

Franklin

Workers' Compensation Fraud and Forgery

Living Maintenance Wage Loss benefits paid when target essentially not working.

5 Years Community Control, $32,468.63 Court Costs and Restitution

Franklin

Workers' Compensation Fraud

Working While Receiving

6 Months Incarceration Suspended for 1 Year $9,358.30 Probation and Restitution

Franklin

Workers' Compensation Fraud

Working While Receiving

30 Days Suspended Sentence, Fine, Court Costs $17,493.80 and Restitution

37

Fine, 90 Days Incarceration Suspended, 1 Year Probation

$15,596.00 Fine and Restitution

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Type

County

Offense

Allegation

Restitution Ordered

Sentence

Claimant

Franklin

Workers' Compensation Fraud

Kiihr, Timothy

Hometown Grills Inc. aka Westerville Grille Employer

Franklin

Failure to Comply

Failure to Pay BWC Premiums

$0.00 5 Years Community Control

Stover, Olive

Apple of God's Eye Christian Daycare

Franklin

Failure to Comply

Failure to Pay BWC Premiums

$0.00 Fine/Costs Suspended

Franklin

Workers' Compensation Fraud

Working While Receiving

90 Days Incarceration Suspended, 1 Year Probation, Court Costs and $4,517.89 Restitution

Franklin

Workers' Compensation Fraud

Falsifying C-84s to get temporary total disability benefits.

5 Years Community Control, Restitution and Court Costs $6,603.11

Franklin

Workers' Compensation Fraud

BWC claimant submitted false wage information and misrepresented the status of his business in order to receive WL.

Cuyahoga

Workers' Compensation Fraud

False Claim

Maybrier, Harold

McCormack, Lori

Bertram, Debora S.

Campbell, Mark S.

Murphy, Delores

Employer

Claimant

Claimant

Claimant

Claimant

38

Working While Receiving

60 Months Community $12,169.69 Control and Restitution

5 Years Probation and $22,342.86 Restitution

1 Year Community Control, $1,648.69 Court Costs and Restitution

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Waldron, Dean

Type

Claimant

Jarmusz, Brenda S.

Claimant

Lambert, Ronald

Claimant

County

Offense

Allegation

Harrison

Failure to Comply

Failure to Pay BWC Premiums

Franklin

Workers' Compensation Fraud

Working While Receiving

Franklin

Forgery

False Claim

Restitution Ordered

Sentence

$0.00 Fine 180 Days Suspended, 2 Years Probation, Court $1,635.75 Costs and Restitution 11 mos. susp. 5 yrs. community control, court costs, investigative costs, restitution and 100 hrs. $845.00 community. service.

5 Years Community Control, 75 Hrs. Community Service, 63 Days Jail Time Credit and $7,165.02 Restitution

Claimant

Franklin

Forgery

Working While Receiving

Employer

Cuyahoga

Failure to Comply

Failure to Pay BWC Premiums

Claimant

Franklin

Workers' Compensation Fraud

Working While Receiving

Ramsdell, Seth

Botanical Arts Lawn & Landscape

Employer

Lucas

Failure to Comply

Failure to Pay BWC Premiums

$0.00 Costs $79.00

Meng, Alesia L.

Mengs Donut Shop

Employer

Lorain

Failure to Comply

Failure to Pay BWC Premiums

30 Days Jail Suspended and $0.00 Fine

Blanchard, Anthony

Manningham, Gail

Angelic Transporation

Spadafore, John

39

Fine & Court Costs $0.00 Suspended 3 Years Community Control, Restitution and Investigative $17,622.79 Costs

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Lovsey Warren V.

Claimant

Layne, Brian M.

Hoeph, Shawn

Claimant

Shawn's Place dba Italiano's Pizza Employer

Harlow-Wentland, Tina M.

Employer

Smith, Hattie

Bigelow, Michael J.

Wilburn, Barry

Type

Claimant

The Body Shop

County

Offense

Allegation

Restitution Ordered

Sentence

Franklin

Workers' Compensation Fraud

A deceased Widow/Death Benefit recipient's son forged his deceased mother's name and cashed BWC warrants after her death.

Franklin

Workers' Compensation Fraud

Working While Receiving

25 Hrs. Community Service $1,481.14 and Fine

Stark

Failure to Comply

Failure to Pay BWC Premiums

Fine $150, Costs $98, 30 $0.00 Days Jail Suspended

Lucas

Failure to Comply and Passing Bad Checks

Failure to Pay BWC Premiums

Fine Suspended, Court Cost Suspended and 6 Months $0.00 Probation

Franklin

Workers' Compensation Fraud

Cashed Deceased Claimant's BWC Checks.

Failure to Comply Workers' Compensation Fraud

Failure to Pay BWC Premiums

Employer

Lucas

Claimant

Franklin

40

Working While Receiving

5 Years Probation and $14,630.00 Restitution

90 Days Suspended and $913.82 Restitution $300.00 Fine Suspended, $60.00 Cost Suspended, 40 $0.00 Hours. Community Service 180 Days Suspended for 3 Years Community Control $4,655.82 and Restitution

Attachment C WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005

Person Convicted

Employer

Type

County

Seaman, John Louis Sr. Revere Travel

Employer

Cuyahoga

Owens, Jerry

Claimant

Franklin

Whitmore, Genevieve

Claimant

Franklin

Camp, Karen

Claimant

Franklin

Offense

Failure to Comply Workers' Compensation Fraud Workers' Compensation Fraud Workers' Compensation Fraud

41

Allegation

Failure to Pay BWC Premiums

False Claim Working While Receiving Working While Receiving

Restitution Ordered

$0.00

$876.03

$4,039.00

$7,327.00 $1,223,993.91

Sentence

Fine, 90 Days Incarceration Suspended, 2 Years Probation 3 Years Probation, Investigative. Costs and Restitution 6 Months Suspended provided court costs are paid by 6/1/06. 30 Days Jail Suspended Pending 2 Years Probation and Restitution

Ohio Attorney General Jim Petro Health Care Fraud Section 150 East Gay Street 17th Floor Columbus, Ohio 43215 Telephone 1-800-64-ABUSE or 1-800-642-2873 E-mail: [email protected] http://www.ag.state.oh.us