Medicare Fraud Reports From the Office of Inspector General and Recent State Enforcement Actions

August 2015

August 31, 2015; Tennessee Department of Finance and Administration: Two Coffee County Residents Charged With TennCare Fraud
August 27, 2015; Florida Attorney General: Lake County Assisted Living Facility Owner Arrested for Neglect in Connection with Sex Crimes
TALLAHASSEE, Fla.-Attorney General Pam Bondi's Medicaid Fraud Control Unit, the Eustis Police Department and the Lake County Sheriff's Office arrested a Lake County woman, Malaya Prado Maulion, 41, for allegedly housing a male resident with a known history of sexual deviancy at an assisted living facility Maulion owns.
August 24, 2015; New York Attorney General: A.G. Schneiderman Announces $6 Million Medicaid Settlement With Brooklyn Home Care Agency
NEW YORK - Attorney General Eric T. Schneiderman today announced a $6 million dollar settlement with Empire State Home Care Services, Inc. (Empire), a home care agency operating out of Brooklyn, NY. The settlement resolves claims that Empire improperly reported its home health aide hours as well as administrative and general expenses on cost reports filed between 2002 and 2005. These cost reports were used to set the reimbursement rates that Empire received from the state for the years 2004 through 2007 and resulted in over $3 million in reimbursements to which Empire was not entitled.
August 24, 2015; New York Attorney General: A.G. Schneiderman Announces $8 Million In Settlements With Specialcare Hospital Management Corp. And Hospitals In Yonkers, Kingston And Hudson For Defrauding Medicaid
NEW YORK- Attorney General Eric T. Schneiderman today announced that his office has secured settlement agreements with five defendants in a False Claims Act case that will return more than $8 million to the Medicaid and Medicare programs. The agreements resolve claims that SpecialCare Hospital Management Corporation defrauded Medicaid and Medicare by illegally referring patients to unlicensed drug and alcohol treatment programs at Columbia Memorial Hospital in Hudson, and St. Joseph's Medical Center in Yonkers, in exchange for kickbacks.
August 24, 2015; Florida Attorney General: Mother and Daughter Arrested for Medicaid Fraud and Grand Theft
TALLAHASSEE, Fla.-Attorney General Pam Bondi's Medicaid Fraud Control Unit today announced the arrests of a private duty nurse and her daughter for Medicaid provider fraud and grand theft in Bay County, Fla. Kimberly Mills, 49, while employed as a private duty nurse, allegedly stole more than $50,000 from her employer and submitted billing records of more than $100,000 for filing claims that are not reimbursable by Medicaid. According to the investigation, Kayla Moore, 28, Mills' daughter, aided and abetted her mother in the fraudulent filings.
August 21, 2015; Louisiana Attorney General: AG Caldwell's Medicaid Fraud Control Unit Arrests New Orleans Woman
Attorney General James D. "Buddy" Caldwell announced today that a New Orleans woman has been charged with two counts of Medicaid fraud.
August 19, 2015; Florida Attorney General: Okaloosa County Resident Arrested for Exploitation of the Elderly
TALLAHASSEE, Fla.-Attorney General Pam Bondi's Medicaid Fraud Control Unit and Okaloosa County Sheriff's Office this week arrested an Okaloosa County woman, Megan Sanai, 31, for exploitation of the elderly. According to the investigation, Sanai knowingly purchased goods with the private funds of an elderly adult that was mentally incapable of making legal and financial decisions.
August 19, 2015; New York Attorney General: A.G. Schneiderman Announces Arrest Of Hamlin Nurse For Diverting Narcotics From Nursing Home Patients
ROCHESTER - Attorney General Eric T. Schneiderman today announced the arrest and arraignment of Amy Shultz, 35, a Registered Nurse from Hamlin, on charges that she allegedly diverted nearly 73 narcotic pills from elderly patients residing at St Ann's Home in Irondequoit.
August 17, 2015; Arkansas Attorney General: Rutledge Announces Medicaid Fraud Arrest of Craighead County Man
LITTLE ROCK - Arkansas Attorney General Leslie Rutledge announced the arrest of a Craighead County man by the Attorney General's Medicaid Fraud Control Unit.
: Escambia County Assisted Living Facility Administrator Sentenced to Prison for Abuse of the Disabled and Assistant Administrator Sentenced for Neglect
TALLAHASSEE, Fla.-Attorney General Pam Bondi's Medicaid Fraud Control Unit announces the convictions of two Escambia County Assisted Living Facility employees for abuse and neglect. According to the investigation, Belie Brock Williams, 73, former Administrator for Kipling Manor, refused psychological nursing caregivers entrance to the facility. Due to this refusal, some residents did not receive care for approximately two to three weeks. Adrienne Taylor, 44, former Assistant Administrator of Kipling Manor, failed to perform as a caregiver by not protecting the residents from abuse and not assuring the residents received the prescribed nursing services.
August 13, 2015; New York Attorney General: A.G. Schneiderman Announces Arrest Of Brooklyn Nursing Home Aide For Allegedly Striking And Abusing Resident
BROOKLYN- Attorney General Eric T. Schneiderman today announced the arrest and arraignment of Mina Maxine Gayle-Campbell, a Certified Nurse Aide on charges she repeatedly struck and mistreated a resident at Shore View Nursing and Rehabilitation Center in Brooklyn. Gayle-Campbell allegedly failed to provide appropriate care to the 82 year old resident suffering from dementia during a bed bath, for which she is charged with hitting and abusing the resident. The incident was captured on video according to court papers.
August 12, 2015; New York Attorney General: A.G. Schneiderman Announces Guilty Plea Of Nurse For Stealing Narcotics From Elderly Nursing Home Residents
ELMIRA - Attorney General Eric T. Schneiderman today announced the guilty plea of Lisa Rumsmoke Clark, age 45, a Licensed Practical Nurse from Watkins Glen, for diverting nearly 200 narcotic pills from elderly patients residing at Elcor Nursing and Rehabilitation Center in Horseheads.
August 11, 2015; New York Attorney General: A.G. Schneiderman Announces Arrest Of Capital Region Nurse Charged With Illegally Obtaining More Than 2,000 Narcotics Using Forged Prescriptions
ALBANY- Attorney General Eric T. Schneiderman today announced the arrest of Linda Masse, 44, a Licensed Practical Nurse (LPN) from Rotterdam, on charges that she illegally obtained narcotics by presenting prescriptions with the forged signature of her employer, a Medicaid provider, to pharmacies.
August 11, 2015; Tennessee Department of Finance and Administration: Campbell Co. Woman Charged With TennCare Fraud
NASHVILLE, Tenn. - A Campbell County woman is charged with TennCare fraud for falsely reporting her income in order to appear eligible for the state's healthcare insurance program.
August 11, 2015; Tennessee Department of Finance and Administration: Shelby Co. Woman Charged With TennCare Drug Fraud
NASHVILLE, Tenn. - A Shelby County woman is charged with TennCare fraud involving doctor shopping, which involves going to multiple doctors in a short period of time to obtain prescription drugs, using TennCare as payment.
August 10, 2015; Nevada Attorney General: Attorney General Laxalt Announces Settlement Sentencing of Las Vegas Man for Medicaid Fraud
Las Vegas, NV - Today, Nevada Attorney General Adam Paul Laxalt announced that Nathanial Davis, 39, of Las Vegas, was sentenced for Medicaid fraud, a category "D" felony. The fraud was committed between October 2011 and October 2013.
August 10, 2015; Tennessee Department of Finance and Administration: Davidson Co. Woman Charged With TennCare Fraud
NASHVILLE, Tenn. - A Davidson County woman is charged with TennCare fraud involving doctor shopping, or using TennCare to go to multiple providers in a short time period to obtain controlled substances.
August 4, 2015; Florida Attorney General: Tallahassee Woman Arrested for More Than $10,000 in Medicaid Fraud
TALLAHASSEE, Fla.-Attorney General Pam Bondi's Medicaid Fraud Control Unit and the Leon County Sheriff's Office today arrested a Tallahassee woman for allegedly defrauding the Florida Medicaid program. Darelene Johnson, 51, the consumer representative for a disabled adult, allegedly submitted more than $10,000 in claims for unauthorized services.
August 3, 2015; Kansas Attorney General: Kansas City man ordered to pay restitution in Medicaid fraud case
KANSAS CITY, Kan. - (August 3, 2015) - A Kansas City, Kan., man was ordered last week to pay restitution related to Medicaid fraud, Kansas Attorney General Derek Schmidt said.

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Medicare Fraud Reports From the Office of Inspector General and Recent State Enforcement Actions

August 2015

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