Case Highlights

Medicaid Provider Fraud Cases

Alfonzo Bailey

Alfonzo Bailey, of Cleveland, Ohio, was convicted in U.S. District Court for the Northern District of Ohio of one count of Conspiracy to Commit Health Care Fraud. Bailey was sentenced to serve 36 months in Federal Prison and three years of supervised release.In addition, he was ordered to pay $3,465,643.33 in restitution to the Ohio Department of Medicaid. Bailey owned and operated Eye for Change Youth and Family Services, an agency that provided mental health counseling to Medicaid recipients. Fraud was pervasive at Eye for Change, including counseling services that were billed to Medicaid but never rendered (including falsified treatment notes), and most services that were rendered were completed by unqualified staff. In all, over 20 employees of Eye for Change were convicted of fraudulent behavior in this scheme.

Geron Tate

Geron Tate, of Mansfield, Ohio, was convicted in Richland County Court of Common Pleas of one count of Aggravated Theft, a felony of the second degree, and Medicaid Fraud, a felony of the third degree.  Mr. Tate was a licensed chemical dependency counselor who owned and operated G.L. Tate & Associates located in Mansfield, Ohio.  Mr. Tate, billed for counseling services he and his business did not provide which included Mr. Tate traveling out of state and billing for more than 24 hours of counseling services in a day.  Additionally, Mr. Tate fraudulently copied and pasted treatment and patient records and only changed the name and date to support his fraudulently billed counseling services.  Mr. Tate was sentenced to serve 6 years in prison and pay restitution of $1,572,386 to the Ohio Department of Medicaid. 

Paul Vernier

Paul Vernier, of West Portsmouth, Ohio, was convicted in the Lawrence County Court of Common Pleas of two counts of Medicaid Fraud, felonies of the fourth degree.  Mr. Vernier owned and operated Community Counseling and Treatment Services, a drug treatment and Medication Assisted Treatment (MAT) services provider with offices in Scioto and Lawrence Counties.  Mr. Vernier submitted claims for Medicaid reimbursement of group counseling services that either did not occur or did not comply with Medicaid’s client-to-counselor ratio requirements and directed staff to falsify treatment notes to facilitate the fraud.   In addition, Vernier up-coded medical somatic claims for Medicaid reimbursement of suboxone administration services. Mr. Vernier was sentenced to serve a total of 18 months in prison, pay a $5,000 fine, forfeiture 3 real properties, and 3 business and checking accounts totaling $1,575,644. 

 
Dr. William Bauer, of Bellevue, Ohio, was convicted in the U.S. District Court for the Northern District of Ohio of 76 Counts of Distribution of Controlled Substances and 25 Counts of Health Care Fraud.  Dr. Bauer, a former medical doctor located in Bellevue, Ohio, was found guilty by a federal jury of prescribing controlled substances to patients without medical necessity and outside the usual course of medical practice.  Dr. Bauer prescribed high doses of opioids and other controlled substances to patients without regard to any improvement in pain level, function, or quality of life. Additionally, Dr. Bauer was found to prescribe dangerous drug combinations, failed to consider a patient’s state of addiction and ignored warning signs of abuse and diversion such as patient family members stealing medication, patients requesting frequent refills, and patients losing prescribed medications.  Dr. Bauer also regularly administered epidural and trigger point injections without medical necessity and failed to meet standard medical procedural requirements.  Dr. Bauer was sentenced to serve a total of 60 months in prison, 1 year of supervised release, to pay restitution totaling $464,098 to Medicare and the Ohio Medicaid program and pay $100,000 as Community Restitution to the Ohio Attorney General’s Crime Victims Services Section and the Ohio Department of Mental Health and Addiction Services. 

Jasmine Hunt

Jasmine Hunt, of Akron, Ohio, was convicted in Franklin County Court of Common Pleas on one count of Medicaid Fraud, a felony of the fourth degree.  Ms. Hunt was an independent home health aide who billed for the same service multiple times and billed for services in excess of 24 hours in a day.  The investigation determined that Ms. Hunt did in fact provide services; however, Ms. Hunt inflated her billing to indicate she provided more services than what was actually provided.  Additionally, investigators determined that Ms. Hunt traveled in and around Ohio on dates and times when her billing indicated she was rendering services.  Ms. Hunt was sentenced to serve 14 months in prison (suspended), serve 4 years community control, and pay restitution of $125,000 to Ohio Medicaid.

Dr. Deepak Raheja

Dr. Deepak Raheja, of Hudson, Ohio, was convicted in U.S. District Court for Northern District of Ohio, of Conspiracy to Solicit, Receive, Offer and Pay Health Care Kickbacks.  Raheja was sentenced to 30 months in Federal prison and ordered to pay over $1,500,000.00 in restitution to the Ohio Department of Medicaid and Ohio’s Medicaid Managed Care entities.  Raheja and three co-conspirators falsified the medical necessity and prior authorization forms submitted to Medicaid for certain prescription drugs in order to receive kickbacks from representatives of the drugs’ manufacturer.  Raheja’s falsification of these forms caused fraudulent claims to Medicaid for prescriptions that did not meet the medical necessity requirements for reimbursement. 

Abdallah Kitwara

Abdallah Kitwara, of Bowie, Maryland, was convicted in Franklin County Common Pleas Court of Medicaid Fraud, a felony of the third degree.  Kitwara was sentenced to serve 36 months in prison (suspended), and five years of Community Control.  Kitwara was also ordered to pay $500,000.00 in restitution to the Ohio Department of Medicaid.  Kitwara owned and operated Vizion One, a home health agency based in Columbus, Ohio. Kitwara’s company billed Medicaid for home health nursing visits, when either no service was provided, or when only lower-reimbursing unskilled home health aide services were provided. 

Dr. Eman Jallaq

Dr. Eman Jallaq DDS, of Grove City, Ohio, was convicted in Franklin County Common Pleas Court of Possession of Criminal Tools, a felony of the fifth degree.  Jallaq was sentenced to 12 months in prison (suspended) and five years of Community Contol.  Jallaq was also ordered to pay $39,746.20 in restitution to the Ohio Department of Medicaid and several of Ohio’s Medicaid Managed Care Entities.  Jallaq operated a Columbus, Ohio based dental practice, and ordered her staff to bill Medicaid for disallowed combinations of dental X-rays in order to increase her practice’s reimbursement from Medicaid. 
 

Patient Abuse/Neglect and Misappropriation Cases

Mark Thomas

Mark Thomas, of St. Clairsville, Ohio, was convicted in U.S. District Court for the Southern District of Ohio of Mail Fraud.  Thomas was sentenced to 60 months in Federal Prison and three years of supervised release.   Thomas was also ordered to pay $882,502.00 in restitution to the victim.   Thomas is a former attorney whose license to practice law in the state of Ohio (and two other states as well) was suspended in 2015.  He served as Power of Attorney for a 92-year-old female long-term care facility resident and used this legal authority to misappropriate her money for his personal use, all the while purporting to act in her best interests.

McKayala Staffey
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McKayla Staffey, of Adamsville, Ohio, was convicted in Muskingum County Common Pleas Court of Attempted Identity Fraud Against a Person in a Protected Class, a felony of the third degree; Telecommunications Fraud, a felony of the third degree; two counts of Forgery, felonies of the fourth degree; and two counts of Theft, felonies of the fifth degree.   Staffey was an aide at a Zanesville long-term care facility who stole over $8,000.00 from three residents of the facility.  Staffey wrote checks to herself from the residents’ bank accounts and used their debit account information to make purchases of personal items for herself from numerous retailers.   Staffey was sentenced to 48 months in prison and ordered to pay $8,016.98 to the victims.

Benjamin Stetser

Benjamin Stetser, of Fostoria, Ohio, was convicted in Ottawa County Common Pleas Court for Patient Abuse, a felony of the fourth degree. Stetser was sentenced to up to 18 months imprisonment (suspended) and three years of Community Control. Stetser was also ordered to serve 30 days in the Ottawa County Detention Facility.  Stetser was a state tested nursing assistant who worked at a nursing facility in Williston, Ohio.  Stetser was providing care to a wheelchair bound, non-verbal resident of the facility when he was witnessed slapping the resident across the face three times.

Cassandra Gillum

Doniqua Jones

Doniqua Jones, of Akron, Ohio, was convicted in Summit County Common Pleas Court of Involuntary Manslaughter, a felony of the third degree.  Jones was sentenced to up to 36 months imprisonment (suspended) and three years of Community Control.  Jones was a nurse at a nursing facility in Richfield.  While Jones was working a shift, a resident eloped from the facility and died from hypothermia.  Jones spent most of this shift studying at the nurses’ station instead of checking on patients.  After the resident was discovered by other facility employees, but prior to the 911 call alerting authorities, Jones logged into the facility computer and fabricated a note indicating she had seen the resident overnight. Based on surveillance footage, this was proven to be untrue, and Jones eventually admitted the note was a fabrication to protect her from suspicion.

Mary Pavlic

Mary Pavlic, of Cleveland, Ohio, was convicted in Parma, Ohio, Municipal Court of Gross Patient Neglect, a misdemeanor of the first degree; Tampering with Records, a misdemeanor of the first degree; and Patient Neglect, a misdemeanor of the second degree.  Pavlic was ordered to serve 90 days in the Cuyahoga County Jail and 36 months of probation.  Pavlic was a nurse at a Parma long-term care facility.  Pavlic was informed by an aide that a resident had what appeared to be the beginning of a bedsore.  Pavlic did absolutely nothing about the bedsore, including no treatment nor documentation.  The wound was eventually rediscovered by other staff a few days later, but by then, the bedsore had progressed to the size of a fist and would eventually tunnel down to the bone.

Lisa Mauch

Lisa Mauch, of Gallipolis Ferry, West Virginia, was convicted in Gallia County Common Pleas Court of three counts of Theft of Drugs and three counts of Illegal Processing of Drug Documents, all felonies of the fourth degree.  Mauch was sentenced to up to 18 months imprisonment on each count (suspended) and 36 months of Community Control.  Mauch was a nurse at a Gallipolis long term care facility who stole 46 narcotic pills (Oxycodone/Hydrocodone) from the facility for personal use and altered facility records to conceal her thefts. 

 Workers’ Compensation Fraud Cases

Lawrence Wells

Lawrence Wells, of Cincinnati, Ohio, was convicted in Franklin County Common Pleas Court of Workers’ Compensation Fraud and Forgery, both felonies of the fourth degree.  Wells was sentenced to up to 36 months imprisonment (suspended) and one year of Community Control.   Wells was also ordered to pay $170,000.00 in restitution to the Ohio Bureau of Workers’ Compensation (BWC).   Wells, a chiropractor, billed BWC for services not provided to injured workers, including for times when Wells himself was hospitalized. 

Larry Brown David Gentrup