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Case Highlights

Medicaid Provider Fraud Cases

Dr. Roger Anderson

Dr. Roger Anderson was convicted in U.S. District Court for the Southern District of Ohio of one count of conspiracy to dispense and distribute controlled substances, eight counts of illegal dispensing or distribution of Schedule II controlled substances, and one count of health care fraud.  Anderson was sentenced to serve 96 months in a federal prison and three years of supervised release.  In addition, he was fined $4,000 and ordered to pay restitution of $22,627.89.  Anderson was a physician practicing in Marietta, Ohio.  He prescribed controlled substances without a legitimate medical purpose and outside the usual course of medical practice.  Specifically, he wrote prescriptions for controlled substances without a medical examination and charting, saw patients after hours and outside his practice, and pre-signed prescriptions.  He also up-coded office visits billed to Medicaid, Medicare and the Ohio Bureau of Workers’ Compensation.

Dr. George Griffin

Dr. George Griffin was convicted in U.S. District Court for the Southern District of Ohio of unlawful distribution and dispensing of controlled substances, and was sentenced to serve 40 months in prison and three years of supervised release.  Griffin prescribed narcotic pain medication that an expert determined to be medically unnecessary.  He regularly prescribed narcotics without corresponding medical visits or with visits supported only by “cloned” medical records, and he overlooked inconsistent urine drug screens.  In addition, he ignored drug seeking behavior and evidence that his patients were diverting the drugs he prescribed.  It is also worthy of note that a number of his patients died of drug overdoses.

Dr. Morris Brown

Dr.
Morris Brown pled guilty in the U.S. District Court for the Southern District of Ohio to one count of unlawful distribution of controlled substances, and was sentenced to serve 24 months in prison and three years of supervised release.  Dr. Brown owned and operated Dayton Primary Care, and he prescribed controlled substances outside the standard of care for a primary care physician.  He regularly prescribed medically unnecessary opioid pain medications, including overlapping prescriptions and early refills.  Dr. Brown prescribed to patients without obtaining the appropriate patient histories and without running the appropriate drug screens.  For the patients he did screen, the patients tested positive for illicit drugs and negative for the drugs prescribed by Dr. Brown.  Several of Dr. Brown's patients died while in his care.  Brown's co-conspirators owned and operated Dayton Pharmacy, which was located in the same building as Brown's medical practice.  They leased the space from Brown, and conspired with him to fill improper prescriptions for controlled substances.
 
Martez Morris

Martez Morris pled guilty to one count each of identify fraud (F2), tampering with public records (F3), Medicaid fraud (F4), practicing nursing without a license (F5), and endangering children (M1), and was sentenced to serve four years in prison (suspended) and three years of community control.  Morris had already served 254 days in jail prior to posting bond.  In addition, he was ordered to pay $103,964.26 in restitution to the Ohio Department of Medicaid.  Morris, who has only a high school diploma, stole the identity of a Licensed Practical Nurse, and used her identity and fraudulent documents to obtain employment with at least two home health agencies in the Cincinnati area.  While so employed, Morris performed skilled nursing services for a number of Medicaid recipients, including a disabled adult and several children.  Morris performed breathing treatments, medication administration, and G-tube maintenance, all without competent medical supervision.  In addition, Morris claimed to be a resident physician at Cincinnati Children’s Hospital, and claimed to have a Master’s degree in Biochemistry.

Dr. Kedar Deshpande‚Äč

Dr. Kedar Deshpande was convicted of unlawful distribution of controlled substances and false statements relating to health care matters in U.S. District Court for the Southern District of Ohio, and was sentenced to serve one day in jail, twelve months of home detention, and three years of supervised release.  In addition, he was ordered to pay restitution in the amount of $117,124.88.  Deshpande ran a pain management clinic in Columbus, and (1) pre-signed prescriptions distributed by his office staff, (2) billed for office visits provided by unqualified staff, and (3) billed for the services of an uncredentialed provider using his own provider number.

Aduke McCoy

Aduke McCoy and National Committee on Youth, Inc. were each convicted of one count of Medicaid Fraud (F3).  McCoy, the corporation’s Director, was sentenced to serve three years in prison (suspended) and three years of community control, and both defendants were ordered to pay restitution (joint and several liability) of $504,304.05 to the Ohio Department of Medicaid.  National Committee on Youth, a Kentucky not-for-profit corporation, contracted with Medicaid to provide counseling services for minors in the greater Cincinnati area.  Our investigation revealed that it did not provide the services for which it sought Medicaid reimbursement, but instead created and maintained false records to make it appear as though the services had been rendered, and altered records produced pursuant to a grand jury subpoena issued as part of the investigation.

Terry Hill, Jr.
 
Terry Hill, Jr. was convicted of Medicaid fraud (F3), and was sentenced to serve 18 months in prison (suspended) and three years of community control.  In addition, he was ordered to pay restitution to the Ohio Department of Medicaid and five of its contract managed care plans, totaling $167,599.52.  Hill was a Licensed Professional Clinical Counselor and the owner of New Horizons Therapeutic Services in Dayton, a chemical dependency counseling service under contract with Medicaid.  Hill submitted claims for Medicaid reimbursement of services he did not provide, including services allegedly rendered to: (1) patients he had never actually seen; (2) patients who were no longer receiving care at New Horizons; (3) a patient who was deceased; and (4) patients who were incarcerated during the times they allegedly received services.

Dr. Jimmy Henry

Dr. Jimmy Henry pled guilty in U.S. District Court for the Southern District of Ohio to one count of conspiracy to unlawfully distribute controlled substances and one count of violating the anti-kickback statute.  Dr. Henry agreed to permanently surrender his medical license and his DEA registration and agreed to pay $264,240.52 in restitution to Medicare, Medicaid, and the Ohio Bureau of Workers’ Compensation.  Of the total, $214,366.50 is apportioned to Ohio Medicaid.  Dr. Henry owned and operated Midwest Spine and Pain, with offices in New Albany and Lewis Center, and he prescribed controlled substances, including highly addictive opioids, outside the usual course of practice and for other than legitimate medical purposes.  In addition, Dr. Henry received kickbacks from Insys Therapeutics as part of a fraudulent “Speakers Program” marketing the company’s fentanyl-based sublingual spray, Subsys.

Kayode Adeyemi

Kayode Adeyemi was convicted of Medicaid fraud (F4) and was sentenced to serve 14 months in prison (suspended) and three years of community control.  In addition, he was ordered to pay restitution in an amount to be determined during a scheduled December 8th restitution hearing.  Adeyemi, a Registered Nurse and independent home health provider, submitted claims for Medicaid reimbursement of services he did not provide to recipient Stacey Conner, including over $100,000 in services he allegedly rendered while he was outside the state / country.  Connor was complicit in the crime, signing Adeyemi’s timesheets for services she knew he did not provide, in exchange for cash and/or assistance paying her bills.  At one point, Adeyemi was paying Connor as much as $700 per month in kickbacks.  In total, the defendants caused a loss to the Medicaid program of $359,545.17.  Conner too has been convicted for her role in this scheme to defraud.
 

Patient Abuse/Neglect and Misappropriation Cases

Karen Emerson

Karen Emerson was convicted of gross patient neglect and was sentenced to serve 180 days in jail (suspended) and two year of probation.  In addition, she was fined $500 ($250 suspended).  While employed as a State Tested Nursing Assistant (“STNA”) at the Laurels of Defiance care facility, Emerson attempted to transfer an elderly male resident from his wheelchair to his bed, without the use of a mechanical lift and without the assistance of a second staff member, as required by the patient’s plan of care.  During the transfer, the resident fell to the floor, breaking his leg in two places.  Emerson did not report the fall, but instead left the resident in his bed to suffer overnight.  The resident’s injuries were left unattended until discovered by another employee the following morning, when he was sent to the hospital for treatment.

Christopher Negulis

Christopher Negulis pled guilty in Stark County Common Pleas Court to two counts of failing to provide for a functionally impaired person and one count of forgery, and was sentenced to serve three years of community control on each count.  In addition, he was ordered to abide by all felony conviction requirements and pay the costs of prosecution.  Negulis, an ambulance driver, was tasked with transporting an elderly male resident of the Altercare of Hartsville care facility to a dialysis center for treatment.  The resident is a double above-the-knee amputee and has an order for a cot transfer as he struggles to maintain balance in a wheelchair, particularly when weakened following dialysis.  Despite his knowledge of this order, Negulis elected to transport the resident in a wheelchair during the return trip to the facility.  Not only did Negulis knowingly violate the order, but he failed to secure the front wheels of the wheelchair.  The resident reported that as the vehicle accelerated away from a stoplight, the front wheels of the chair lifted off the deck and the resident tipped backward striking his head on the floor of the transport vehicle.  The resident reported that he alerted Negulis to the fact that he was injured and bleeding, and asked that Negulis transport him to the hospital.  Negulis refused and instead, made some attempt to stop the bleeding and gave the resident Tylenol for the pain.  Negulis then returned the resident to the facility and put him in bed, without reporting the incident to anyone.  The duty nurse discovered the resident in pain and found a hematoma on the back of his head.  The resident was transported to the hospital where it was determined that he had two fractured vertebrae, and the resident was placed in a C-Collar for six weeks.

Brandee Haenning

Brandee Haenning was convicted of one count of patient neglect, and was sentenced to choose between a $750 fine and court costs, or 500 hours of community service.  While employed as a State Tested Nurse Aide at Burlington House Nursing Home in Cincinnati, Haenning attempted to transfer an 86-year old female resident from her wheelchair to her bed.  The patient, who suffers from end-stage Alzheimer’s disease and severe dementia, is non-ambulatory and non-verbal, and requires both a two-person transfer and the use of a mechanical lift.  Despite the fact that Haenning was aware of these orders, as outlined in the patient’s plan of care, she attempted the transfer alone, using what she described as a twisting stand-and-pivot maneuver.  Hours later, Haenning discovered that the patient’s foot was bruised and appeared to be dislocated.  Haenning notified a facility nurse, and the patient was immediately transported to the hospital where she was diagnosed with a spiral fracture.  An orthopedic surgeon was able to repair the break, but the surgery required an incision that ran the full length of the patient’s shin, and more than fourteen metal screws and two metal plates.  Despite the fact that the surgery was considered a success, the patient died just five days later.
 
Whetstone Gardens and Care Center / The Macintosh Company

The Attorney General and the Ohio Department of Medicaid executed a settlement agreement with Whetstone Gardens and Care Center / The Macintosh Company resolving the State’s allegations that Whetstone failed to provide adequate care to Medicaid beneficiaries residing in its facility.  Several employees of the facility have been indicted for criminal acts underlying this settlement.  The settlement agreement subjects Whetstone to a series of business reforms and compliance checks, and returns $130,976 to the Ohio Medicaid program in the form of a civil monetary penalty.

Jennifer Kennedy

Jennifer Kennedy was convicted of patient abuse (F4), and the Court sentenced her to serve 60 days in the county jail and five years of community control.  In addition, she was ordered to submit to random drug testing and complete an anger management program.  Kennedy was employed as a State Tested Nurse Aide at the Country Club Retirement Campus.  While providing care to a resident, the resident spit in Kennedy’s face, and Kennedy backhanded the resident across the face.  The resident spit in Kennedy’s face a second time, and Kennedy again backhanded the resident.

Angela Gallegos

Angela Gallegos was indicted by a Hancock County grand jury for one count of theft from a person in a protected class, a felony of the third degree.  Gallegos served as the Social Security representative payee for her 83-year old father, who is a resident of the St. Catherine’s Manor care facility in Findlay.  As her father’s representative payee, Gallegos was charged with ensuring that her father’s social security benefits were used for his benefit, to include the cost of his care at St. Catherine’s Manor.  But instead of paying the facility for her father’s care, she diverted $34,412.22 for her own personal use.

Steven Perez

Steven Perez was convicted of attempted theft, a felony of the fourth degree, and was sentenced to serve 12 months in prison (suspended) and two years of community control.  Perez financially exploited his 73-year old mother to support himself, while simultaneously failing to provide for her care at the Fairview Skilled Nursing and Rehab facility in Lucas County.

Amanda Corbett, RN

Amanda Corbett, RN pled guilty in Tuscarawas County Court of Common Pleas to one count of theft of drugs (F4) and because the defendant had a prior criminal record, the court sentenced her to serve six months in prison, concurrent with a three-year prison sentence she is currently serving.  While employed as a nurse at the Riverside Manor Nursing and Rehabilitation Center in Newcomerstown, Corbett diverted Norco tablets (Hydrocodone/APAP 5-325 mg) intended for facility residents, and falsified facility Medication Administration Records in an effort to conceal her thefts.
 

Workers’ Compensation Fraud Cases

Daniel Evans

Daniel Evans was convicted in Franklin County Common Pleas Court of one count of workers’ compensation fraud (F4), and was sentenced to serve five years of community control.  In addition, he was ordered to pay restitution to the Ohio Bureau of Workers’ Compensation in the amount of $58,731.41.  Evans was injured while working for Out Source Fleet Services, Inc., and was awarded Total Temporary Disability benefits by the BWC.  The work restrictions of his award notwithstanding, Evans continued to work, running Original Blonde Welding and Fabrication, LLC.
 
William Knox

William Knox was convicted of workers’ compensation fraud (F4) and forgery (F4), and was sentenced to serve seventeen months in jail (suspended) and five years of community control.  In addition, he was ordered to pay restitution in the amount of $131,752.29 to the Ohio Bureau of Workers’ Compensation (“BWC”).  Due to a workplace injury, Knox was awarded Temporary Total Disability, Living Maintenance, and Living Maintenance Wage Loss benefits by the BWC.  However, in his application for these benefits, he falsified his wage information to increase the value of his benefits.

David Garner

David Garner was convicted in Franklin County Common Pleas Court of one count of workers’ compensation fraud (F4), and was sentenced to serve 18 months in prison (suspended) and three years of community control.  In addition, Garner was ordered to pay $151,705.15 in restitution to the Ohio Bureau of Workers’ Compensation “BWC”).  While receiving Temporary Total Disability benefits from BWC as an injured worker, Garner continued to work as both a real estate agent and a real estate broker, in violation of his award.

Larry Brown

Larry Brown was convicted of workers’ compensation fraud (F5) and was sentenced to serve 12 months in prison (suspended) and five years of community control.  In addition, he was ordered to pay restitution of $66,705.98 to the Ohio Bureau of Workers’ Compensation (“BWC”).  Following a workplace injury, Brown was awarded Permanent Total Disability and Disabled Workers Relief Fund benefits by the BWC.  The restrictions of his award notwithstanding, Brown continued to work as a truck driver, and arranged for his employer to direct his paychecks to his wife in an effort to avoid detection.  In addition, he signed numerous BWC documents falsly representing that he was not working.