BRUNSWICK, GA—Schella Logan Hope, 47, of Brunswick, Georgia, was convicted earlier this month by a federal jury of various health care fraud, aggravated identity theft, and money laundering offenses for her role in a $4 million scheme upon the Georgia Medicaid program. Chief United States District Court Judge Lisa Godbey Wood presided over Hope’s five-day jury trial.
According to evidence presented during the trial, Hope was a licensed dietician who ran a business located in Brunswick, Georgia, known as Hope Nutritional Services. From 2005 through 2011, Hope stole the identities of thousands of needy children between the ages of zero and five that were enrolled in Head Start programs located throughout the state of Georgia. Once Hope obtained the identities of these children, Hope fabricated patient files, falsified prescriptions from doctors, and submitted $4 million worth of claims to Medicaid for nutritional services that were not provided. Hope then used the money she stole from Medicaid to pay for luxury automobiles, designer clothing, and vacations, among other things.
Co-conspirator Arlene Murrell pled guilty before Hope’s trial to her role in the scheme. Murrell testified against Hope at trial and detailed how she helped Hope commit the fraud.
Hope was convicted of 58 counts of conspiracy to commit health care fraud; health care fraud; aggravated identity theft; and money laundering. Upon her convictions for these offenses, Chief Judge Wood remanded Hope to the custody of the United States Marshals pending sentencing in the case.
United States Attorney Edward J. Tarver stated, “Defendant Hope preyed upon American taxpayers by stealing the identities of low-income Georgia families and then billing Medicaid for over $4 million in nutrition services that were never provided. This United States Attorney’s Office will continue its efforts to prosecute all who seek to defraud American taxpayers by scamming federal programs. Because of Ms. Hope’s criminal efforts to feed her extravagant lifestyle, she will have to rely upon the federal prison system for her own nutritional services.”
“The Head Start Program provides many of our nation’s children with invaluable services and opportunities,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General, Atlanta Regional Office. “To use the Head Start Program as a vehicle to submit false and fraudulent claims to the Medicaid system is unacceptable, and the OIG will continue to pursue these kinds of egregious cases.“
Mark F. Giuliano, Special Agent in Charge, FBI Atlanta Field Office, stated, “Those who defraud our publicly funded healthcare programs such as Medicaid and Medicare are taking valuable services and resources away from those in need. This guilty verdict reaffirms that the FBI will continue to provide significant investigative resources toward identifying, investigating, and presenting for prosecution such individuals that, by engaging in such criminal conduct, put themselves before others."
Georgia Attorney General Sam Olens said, “Fraud of taxpayer monies will not be tolerated in any form. Head Start is a program intended to offer assistance to children from low income families. The fact that this defendant used the Head Start Program and children in need to assist in her scam is especially appalling.”
“The Georgia Department of Community Health has made it a top priority to ferret out fraud, waste, and abuse in our Medicaid program. Our collaborative work with state and federal agencies enables us to ensure Medicaid program dollars are being used to provide health care services to Georgia’s most vulnerable populations,” said Clyde L. Reese, III, Esq., commissioner of the Georgia Department of Community Health.
At sentencing, Hope faces 10 years in prison for each of the 17 health care fraud offenses; 20 years in prison for the various money laundering offenses; and two years consecutive prison sentences for each of the various aggravated identity theft offenses. Hope also faces up to three years of supervised release and may be ordered to pay restitution to the victims in this case.
The convictions of Hope and Murrell resulted from a joint investigation by the United States Department of Health and Human Services, Office of Inspector General; the Federal Bureau of Investigation; Georgia’s Department of Community Health; and the Georgia Attorney General’s Medicaid Fraud Control Unit.
Assistant United States Attorneys Brian T. Rafferty and David Stewart, along with Assistant Attorney General Robin Daitch, prosecuted the case on behalf of the United States. For additional information, please contact First Assistant United States Attorney James D. Durham at (912) 201-2547.
Showing posts with label identity theft. Show all posts
Showing posts with label identity theft. Show all posts
Thursday, November 21, 2013
Friday, February 8, 2013
Eleven People Arrested in New Jersey in Large-Scale Medicaid Fraud Scheme
NEWARK—Federal and state agents this morning arrested 11 people who are charged by complaint, along with two corporations, in connection with a large-scale scheme to defraud the Medicaid program of millions of dollars, U.S. Attorney Paul J. Fishman announced today.
The complaint also charges the owner of a home health aide business headquartered in Linden, New Jersey, with attempting on two occasions to hinder a state investigation by bribing a state regulator—who was working with the FBI—and with conspiring with the owner of another home health aide business in Elizabeth, New Jersey, to launder money.
The defendants arrested this morning are scheduled to appear this afternoon before U.S. Magistrate Judge Madeline Cox Arleo in Newark federal court.
“The defendants in this case allegedly enriched themselves by gaming the Medicaid system,” U.S. Attorney Fishman said. “The actions described in this complaint are especially egregious, because the taxpayer dollars that were stolen were intended to provide necessary health care for our most vulnerable citizens. I’m especially proud that federal and state law enforcement agencies worked together effectively to uncover this alleged fraud.”
David Velazquez, Acting Special Agent in Charge of the FBI, Newark, said, “The FBI views health care fraud as a severe crime problem that poses a potential risk to patients and increases health care costs for all. Today’s arrests are the result of a four-year investigation into a sophisticated scheme involving multiple layers of fraud, money laundering, and bribery, in order to defraud the New Jersey Medicaid program of millions of dollars. This case is indicative of how the FBI, along with its federal partners and the state of New Jersey, will continue to work together to pursue those that steal from our health care system.”
“Falsely billing Medicaid for millions of dollars as alleged in today’s complaint is a serious crime,” Internal Revenue Service (IRS) Criminal Investigation Acting Special Agent in Charge Shantelle P. Kitchen, Newark Field Office, said. “Financial fraud schemes such as this are often described as a house of cards. The underlying structure can fall apart at any time and expose the individuals responsible. IRS-Criminal Investigation is committed to unraveling complex financial transactions and money laundering schemes where individuals attempt to conceal the true source of their money.”
New Jersey Attorney General Jeffrey Chiesa said, “The New Jersey Division of Consumer Affairs regulates nurses, home health aides, and home health agencies in our state and the Division’s Enforcement Bureau aggressively investigates any allegations of fraud or wrongdoing by those regulated professionals and businesses. We are proud to have worked with the FBI on this investigation. Alleged billing fraud by health professionals affects the entire economy and will not be tolerated.”
According to the complaint filed in this case:
Irina Krutoyarsky, 58, of Springfield, New Jersey, was the owner and operator of HHCH Health Care Inc., a for-profit home health aide business located in Linden. HHCH billed Medicaid for services purportedly provided by home health aides to Medicaid-eligible patients. Medicaid is a jointly funded federal-state health insurance program that provides certain health benefits to the disabled and individuals and families with low incomes and resources. Paul Mil, 68, of Springfield, was the owner and operator of People Choice Home Care Inc., another for-profit home health business located in Linden and Elizabeth, which also billed Medicaid for services purportedly provided by home health aides.
Krutoyarsky, Mil, and their conspirators allegedly defrauded Medicaid of millions of dollars through a variety of schemes, including:
During the investigation, an individual working with the FBI—“Cooperating Witness Three” (CW3)—met Krutoyarsky, Mil, and others at HHCH and consensually recorded a number of conversations. For example, on January 31, 2012, CW3 met with Krutoyarsky and Mil to discuss obtaining a home health aide license. During this consensually recorded conversation (audio and video), they discussed fraudulently billing Medicaid by providing false information about the patients, known as a “bait and switch”:
Krutoyarsky: You know, it’s just the free money...coming in.
CW3: That’s true.
Mil described how they billed Medicaid for services not actually rendered:
Mil: It’s a lot of people, a lot of people who...Medicaid. Government pay for the service. We can get, you know, between 10 and 18 hours [of Medicaid billing per week per patient]. Look, people can work in a week and get paid hundred bucks a week doing nothing. Why not?
CW3: Oh, so, otherwise they will trace. Okay.
Krutoyarsky: Because they do the tracings, you know. They gonna see who’s working, who’s not working, this and that....So this way, they gonna have a free money....Government, free money.
After meeting with Krutoyarsky and Mil, CW3 met with defendant Nekadam S. Galibova, an HHCH office employee who assisted CW3 in obtaining a home health aide license without taking the required course or test. CW3 underwent neither the required training nor testing, but in March 2012, CW3 received a home health aide license from the New Jersey. Krutoyarsky, Mil, and others billed Medicaid under CW3’s license, knowing that CW3 provided no treatment to any patients.
Galibova was also a purported HHCH home health aide. The investigation revealed that she conspired with Krutoyarsky and others to bill Medicaid for services not rendered. Galibova and HHCH billed Medicaid for a patient (referred to as Patient M.N.) from July 27 to 31, 2009 and August 3 to 4, 2009, periods when that patient was, in fact, out of the country.
Krutoyarsky and Mil also dispatched undocumented aliens and other unlicensed individuals to patients’ homes. Defendant Sonia Mesa was observed by the FBI visiting a patient’s home; however, Medicaid was billed using the names of others, including Alla Neymet and Leonora Popesku.
Krutoyarsky also bribed a New Jersey Department of Labor employee on two occasions to stop wage and hour investigations into HHCH and People Choice. This state employee, however, was cooperating with the FBI and is referred to in the Complaint as “Cooperating Witness Two” (CW2). On June 14, 2010, Krutoyarsky met CW2 about the state investigation into HHCH. Krutoyarsky did not want to provide CW2 with records related the HHCH and handed CW2 an envelope containing approximately $1,000 in cash.
Krutoyarsky and CW2 passed notes back and forth, negotiating the bribe. Eventually, Krutoyarsky agreed to pay CW2 $10,000, which she later paid. On April 14, 2011, Krutoyarsky paid another $15,000 to CW2 to subvert a state investigation into People Choice.
Krutoyarsky and Mil then allegedly laundered the proceeds of the Medicaid fraud to conceal their scheme and allow it to continue. Krutoyarsky and defendant Gulmira Shayakhmetova are alleged to have conspired to structure money by making numerous cash withdrawals in amounts under $10,000 to evade the banks requirement to file a report with the U.S. Treasury.
Count one charges conspiracy to commit health care fraud and carries a maximum penalty of 20 years in prison and a $250,000 fine. Counts two and three each charge bribery and each charge carries a maximum penalty of 10 years in prison and a $250,000 fine. Count four charges conspiracy to commit money laundering and carries a maximum penalty of 20 years in prison and a $500,000 fine. Count five charges conspiracy to unlawfully structure financial transactions and carries a maximum penalty of five years in prison and a $250,000 fine.
In addition, HHCH and People Choice were charged in count one of the criminal complaint with conspiracy to commit health care fraud.
The criminal complaint also alleges forfeiture and provides notice of the federal government’s intent to forfeit at least $3.45 million in proceeds from the alleged offense and numerous properties in Krutoyarsky’s name in New Jersey, Florida, and New York.
U.S. Attorney Fishman praised agents of the FBI, under the direction of Acting Special Agent in Charge David Velazquez in Newark; IRS-Criminal Investigation, under the direction of Acting Special Agent in Charge Shantelle P. Kitchen; U.S. Citizenship and Immigration Services; New Jersey Attorney General Jeffrey Chiesa; New Jersey State Comptroller Matthew Boxer; Division Director Mark Anderson, Office of the State Comptroller, Medicaid Fraud Division; New Jersey Division of Consumer Affairs, under the direction of Director Eric T. Kanefsky, Board of Nursing; Hal Wirth, Commissioner, New Jersey Department of Labor; U.S. Department of State-Diplomatic Security; and the Marlboro Police Department, under the direction of Chief Bruce Hall, for the investigation leading to today’s charges.
The government is represented by Assistant U.S. Attorneys Anthony Moscato and Jonathan W. Romankow of the Organized Crime/Gangs Unit, Lakshmi Srinivasan Herman of the Economic Crimes Unit and Peter W. Gaeta of the Asset Forfeiture and Money Laundering Unit.
The charges and allegations contained in the complaint are merely accusations, and the defendants are considered innocent unless and until proven guilty.
The complaint also charges the owner of a home health aide business headquartered in Linden, New Jersey, with attempting on two occasions to hinder a state investigation by bribing a state regulator—who was working with the FBI—and with conspiring with the owner of another home health aide business in Elizabeth, New Jersey, to launder money.
The defendants arrested this morning are scheduled to appear this afternoon before U.S. Magistrate Judge Madeline Cox Arleo in Newark federal court.
“The defendants in this case allegedly enriched themselves by gaming the Medicaid system,” U.S. Attorney Fishman said. “The actions described in this complaint are especially egregious, because the taxpayer dollars that were stolen were intended to provide necessary health care for our most vulnerable citizens. I’m especially proud that federal and state law enforcement agencies worked together effectively to uncover this alleged fraud.”
David Velazquez, Acting Special Agent in Charge of the FBI, Newark, said, “The FBI views health care fraud as a severe crime problem that poses a potential risk to patients and increases health care costs for all. Today’s arrests are the result of a four-year investigation into a sophisticated scheme involving multiple layers of fraud, money laundering, and bribery, in order to defraud the New Jersey Medicaid program of millions of dollars. This case is indicative of how the FBI, along with its federal partners and the state of New Jersey, will continue to work together to pursue those that steal from our health care system.”
“Falsely billing Medicaid for millions of dollars as alleged in today’s complaint is a serious crime,” Internal Revenue Service (IRS) Criminal Investigation Acting Special Agent in Charge Shantelle P. Kitchen, Newark Field Office, said. “Financial fraud schemes such as this are often described as a house of cards. The underlying structure can fall apart at any time and expose the individuals responsible. IRS-Criminal Investigation is committed to unraveling complex financial transactions and money laundering schemes where individuals attempt to conceal the true source of their money.”
New Jersey Attorney General Jeffrey Chiesa said, “The New Jersey Division of Consumer Affairs regulates nurses, home health aides, and home health agencies in our state and the Division’s Enforcement Bureau aggressively investigates any allegations of fraud or wrongdoing by those regulated professionals and businesses. We are proud to have worked with the FBI on this investigation. Alleged billing fraud by health professionals affects the entire economy and will not be tolerated.”
According to the complaint filed in this case:
Irina Krutoyarsky, 58, of Springfield, New Jersey, was the owner and operator of HHCH Health Care Inc., a for-profit home health aide business located in Linden. HHCH billed Medicaid for services purportedly provided by home health aides to Medicaid-eligible patients. Medicaid is a jointly funded federal-state health insurance program that provides certain health benefits to the disabled and individuals and families with low incomes and resources. Paul Mil, 68, of Springfield, was the owner and operator of People Choice Home Care Inc., another for-profit home health business located in Linden and Elizabeth, which also billed Medicaid for services purportedly provided by home health aides.
Krutoyarsky, Mil, and their conspirators allegedly defrauded Medicaid of millions of dollars through a variety of schemes, including:
- Billing Medicaid for treatment and services not actually rendered;
- Obtaining fraudulent home health aide certifications for employees and others;
- Using illegal aliens and/or non-certified individuals to provide home health aide services and billing Medicaid, claiming the services had been provided by certified home health aides.
During the investigation, an individual working with the FBI—“Cooperating Witness Three” (CW3)—met Krutoyarsky, Mil, and others at HHCH and consensually recorded a number of conversations. For example, on January 31, 2012, CW3 met with Krutoyarsky and Mil to discuss obtaining a home health aide license. During this consensually recorded conversation (audio and video), they discussed fraudulently billing Medicaid by providing false information about the patients, known as a “bait and switch”:
Krutoyarsky: You know, it’s just the free money...coming in.
CW3: That’s true.
Mil described how they billed Medicaid for services not actually rendered:
Mil: It’s a lot of people, a lot of people who...Medicaid. Government pay for the service. We can get, you know, between 10 and 18 hours [of Medicaid billing per week per patient]. Look, people can work in a week and get paid hundred bucks a week doing nothing. Why not?
* * * *
Krutoyarsky: ...But as long as these people doesn’t live in the same address, so Medicaid is not gonna trace.CW3: Oh, so, otherwise they will trace. Okay.
Krutoyarsky: Because they do the tracings, you know. They gonna see who’s working, who’s not working, this and that....So this way, they gonna have a free money....Government, free money.
After meeting with Krutoyarsky and Mil, CW3 met with defendant Nekadam S. Galibova, an HHCH office employee who assisted CW3 in obtaining a home health aide license without taking the required course or test. CW3 underwent neither the required training nor testing, but in March 2012, CW3 received a home health aide license from the New Jersey. Krutoyarsky, Mil, and others billed Medicaid under CW3’s license, knowing that CW3 provided no treatment to any patients.
Galibova was also a purported HHCH home health aide. The investigation revealed that she conspired with Krutoyarsky and others to bill Medicaid for services not rendered. Galibova and HHCH billed Medicaid for a patient (referred to as Patient M.N.) from July 27 to 31, 2009 and August 3 to 4, 2009, periods when that patient was, in fact, out of the country.
Krutoyarsky and Mil also dispatched undocumented aliens and other unlicensed individuals to patients’ homes. Defendant Sonia Mesa was observed by the FBI visiting a patient’s home; however, Medicaid was billed using the names of others, including Alla Neymet and Leonora Popesku.
Krutoyarsky also bribed a New Jersey Department of Labor employee on two occasions to stop wage and hour investigations into HHCH and People Choice. This state employee, however, was cooperating with the FBI and is referred to in the Complaint as “Cooperating Witness Two” (CW2). On June 14, 2010, Krutoyarsky met CW2 about the state investigation into HHCH. Krutoyarsky did not want to provide CW2 with records related the HHCH and handed CW2 an envelope containing approximately $1,000 in cash.
Krutoyarsky and CW2 passed notes back and forth, negotiating the bribe. Eventually, Krutoyarsky agreed to pay CW2 $10,000, which she later paid. On April 14, 2011, Krutoyarsky paid another $15,000 to CW2 to subvert a state investigation into People Choice.
Krutoyarsky and Mil then allegedly laundered the proceeds of the Medicaid fraud to conceal their scheme and allow it to continue. Krutoyarsky and defendant Gulmira Shayakhmetova are alleged to have conspired to structure money by making numerous cash withdrawals in amounts under $10,000 to evade the banks requirement to file a report with the U.S. Treasury.
Count one charges conspiracy to commit health care fraud and carries a maximum penalty of 20 years in prison and a $250,000 fine. Counts two and three each charge bribery and each charge carries a maximum penalty of 10 years in prison and a $250,000 fine. Count four charges conspiracy to commit money laundering and carries a maximum penalty of 20 years in prison and a $500,000 fine. Count five charges conspiracy to unlawfully structure financial transactions and carries a maximum penalty of five years in prison and a $250,000 fine.
In addition, HHCH and People Choice were charged in count one of the criminal complaint with conspiracy to commit health care fraud.
The criminal complaint also alleges forfeiture and provides notice of the federal government’s intent to forfeit at least $3.45 million in proceeds from the alleged offense and numerous properties in Krutoyarsky’s name in New Jersey, Florida, and New York.
U.S. Attorney Fishman praised agents of the FBI, under the direction of Acting Special Agent in Charge David Velazquez in Newark; IRS-Criminal Investigation, under the direction of Acting Special Agent in Charge Shantelle P. Kitchen; U.S. Citizenship and Immigration Services; New Jersey Attorney General Jeffrey Chiesa; New Jersey State Comptroller Matthew Boxer; Division Director Mark Anderson, Office of the State Comptroller, Medicaid Fraud Division; New Jersey Division of Consumer Affairs, under the direction of Director Eric T. Kanefsky, Board of Nursing; Hal Wirth, Commissioner, New Jersey Department of Labor; U.S. Department of State-Diplomatic Security; and the Marlboro Police Department, under the direction of Chief Bruce Hall, for the investigation leading to today’s charges.
The government is represented by Assistant U.S. Attorneys Anthony Moscato and Jonathan W. Romankow of the Organized Crime/Gangs Unit, Lakshmi Srinivasan Herman of the Economic Crimes Unit and Peter W. Gaeta of the Asset Forfeiture and Money Laundering Unit.
The charges and allegations contained in the complaint are merely accusations, and the defendants are considered innocent unless and until proven guilty.
Wednesday, January 23, 2013
Provider of Home Health Care Services Sentenced for Medicaid Fraud
NORFOLK, VA—Janice W. Holland, 42, of Suffolk, Virginia, was sentenced today to 51 months in prison for health care fraud and alteration of records and a mandatory consecutive sentence of 24 months in prison for aggravated identity theft, for a total sentence of 75 months. She was also ordered to pay restitution to the Virginia Medicaid program in the amount of $630,339.30.
Neil H. MacBride, United States Attorney for the Eastern District of Virginia, and Virginia Attorney General Ken Cuccinelli made the announcement after sentencing by Senior United States District Judge Robert G. Doumar.
Holland pled guilty on September 18, 2012. According to court documents, Holland owned and operated A Caring Hand Home Health Care Services Inc., a business located in Suffolk that was authorized to provide respite care to Medicaid recipients. Respite care is designed to provide temporary, substitute care for a Medicaid recipient that is normally provided by the family or another unpaid primary caregiver of the recipient. These services are provided on a short-term basis because of the emergency absence or need for routine or periodic relief of the primary caregiver. Between January 2008 and October 2011, Holland filed approximately 939 false and fraudulent claims with the Virginia Medicaid program, representing that respite care had been provided by her company to 30 Medicaid recipients, when, in fact, no such care had been provided. She filed these claims using, without authority, the recipients’ names, dates of birth,and Medicaid identification numbers. As a result, Holland obtained health care benefit payments in the approximate amount of $630,339.30, to which she was not entitled. She also altered and falsified her office records to conceal and cover up her false billings.
This case was investigated by the FBI and the Office of the Virginia Attorney General, Medicaid Fraud Control Unit. Assistant United States Attorney Alan M. Salsbury and Special Assistant United States Attorney David W. Tooker prosecuted the case on behalf of the United States.
A copy of this press release may be found on the website of the United States Attorney’s Office for the Eastern District of Virginia at http://www.justice.gov/usao/vae.
Neil H. MacBride, United States Attorney for the Eastern District of Virginia, and Virginia Attorney General Ken Cuccinelli made the announcement after sentencing by Senior United States District Judge Robert G. Doumar.
Holland pled guilty on September 18, 2012. According to court documents, Holland owned and operated A Caring Hand Home Health Care Services Inc., a business located in Suffolk that was authorized to provide respite care to Medicaid recipients. Respite care is designed to provide temporary, substitute care for a Medicaid recipient that is normally provided by the family or another unpaid primary caregiver of the recipient. These services are provided on a short-term basis because of the emergency absence or need for routine or periodic relief of the primary caregiver. Between January 2008 and October 2011, Holland filed approximately 939 false and fraudulent claims with the Virginia Medicaid program, representing that respite care had been provided by her company to 30 Medicaid recipients, when, in fact, no such care had been provided. She filed these claims using, without authority, the recipients’ names, dates of birth,and Medicaid identification numbers. As a result, Holland obtained health care benefit payments in the approximate amount of $630,339.30, to which she was not entitled. She also altered and falsified her office records to conceal and cover up her false billings.
This case was investigated by the FBI and the Office of the Virginia Attorney General, Medicaid Fraud Control Unit. Assistant United States Attorney Alan M. Salsbury and Special Assistant United States Attorney David W. Tooker prosecuted the case on behalf of the United States.
A copy of this press release may be found on the website of the United States Attorney’s Office for the Eastern District of Virginia at http://www.justice.gov/usao/vae.
Thursday, January 10, 2013
Two More Plead Guilty in Patient Data Theft Case
ORLANDO—Sergei Kusyakov (38, Davenport) today pleaded guilty to one count of conspiracy and four counts of wrongful disclosure of individually identifiable health information. Kusyakov faces a maximum penalty of 45 years in federal prison. Sentencing has been set for March 25, 2013.
On December 27, 2012, another conspirator, Katrina Munroe (30, Winter Haven) pleaded guilty to one count of conspiracy. She faces a maximum penalty of five years in federal prison. Sentencing for her has been set for March 11, 2013.
A third conspirator, Dale Munroe, II (35, Winter Haven), pleaded guilty to one count of conspiracy and one count of wrongful disclosure of individually identifiable health information on October 22, 2012. He faces a maximum penalty of 15 years in federal prison. His sentencing has been set for January 14, 2013.
According to their plea agreements, in July 2006, Dale Munroe, II was hired at the Celebration, Florida location of Florida Hospital. During his employment, he worked as a registration representative in the Emergency Department, where he would register patients as they came in the main emergency entrance. From January 2009 until his termination in July 2011, Dale Munroe, II used his position to obtain individually identifiable health information of Florida Hospital patients who had been involved in motor vehicle accidents. Munroe, II would then disclose that information to Kusyakov, who was involved in the operation of two chiropractic clinics (Metro Chiropractic and Wellness Center and City Lights Medical Center). Kusyakov and other conspirators would then use the stolen information to solicit patients of Florida Hospital for chiropractic and legal services. Kusyakov would then pay Munroe for his role in providing the stolen information.
On July 12, 2011, Dale Munroe, II was terminated by Florida Hospital for a patient data breach that was unrelated to the conspiracy described above. Starting about a week after her husband’s termination, Katrina Munroe, who was hired as an insurance representative by Florida Hospital in 2009, was recruited to take over her husband’s role of stealing patient data to be provided to Kusyakov. In August 2012, the data breach was discovered, and Florida Hospital terminated Katrina Munroe shortly after identifying her as a possible suspect. In total, Florida Hospital has identified more than 12,000 patients whose individually identifiable health information was illegally accessed as a part of the conspiracy.
These cases were investigated by the Federal Bureau of Investigation and the Florida Department of Financial Services, Division of Insurance Fraud. They are being prosecuted by Assistant United States Attorney Roger B. Handberg.
On December 27, 2012, another conspirator, Katrina Munroe (30, Winter Haven) pleaded guilty to one count of conspiracy. She faces a maximum penalty of five years in federal prison. Sentencing for her has been set for March 11, 2013.
A third conspirator, Dale Munroe, II (35, Winter Haven), pleaded guilty to one count of conspiracy and one count of wrongful disclosure of individually identifiable health information on October 22, 2012. He faces a maximum penalty of 15 years in federal prison. His sentencing has been set for January 14, 2013.
According to their plea agreements, in July 2006, Dale Munroe, II was hired at the Celebration, Florida location of Florida Hospital. During his employment, he worked as a registration representative in the Emergency Department, where he would register patients as they came in the main emergency entrance. From January 2009 until his termination in July 2011, Dale Munroe, II used his position to obtain individually identifiable health information of Florida Hospital patients who had been involved in motor vehicle accidents. Munroe, II would then disclose that information to Kusyakov, who was involved in the operation of two chiropractic clinics (Metro Chiropractic and Wellness Center and City Lights Medical Center). Kusyakov and other conspirators would then use the stolen information to solicit patients of Florida Hospital for chiropractic and legal services. Kusyakov would then pay Munroe for his role in providing the stolen information.
On July 12, 2011, Dale Munroe, II was terminated by Florida Hospital for a patient data breach that was unrelated to the conspiracy described above. Starting about a week after her husband’s termination, Katrina Munroe, who was hired as an insurance representative by Florida Hospital in 2009, was recruited to take over her husband’s role of stealing patient data to be provided to Kusyakov. In August 2012, the data breach was discovered, and Florida Hospital terminated Katrina Munroe shortly after identifying her as a possible suspect. In total, Florida Hospital has identified more than 12,000 patients whose individually identifiable health information was illegally accessed as a part of the conspiracy.
These cases were investigated by the Federal Bureau of Investigation and the Florida Department of Financial Services, Division of Insurance Fraud. They are being prosecuted by Assistant United States Attorney Roger B. Handberg.
Tuesday, January 8, 2013
Shelby Woman Pleads Guilty to Defrauding Medicaid of $8 Million, Aggravated Identity Theft, and Tax Fraud
CHARLOTTE—A Shelby, North Carolina woman pleaded guilty today for her involvement in a health care fraud scheme that defrauded Medicaid of $8 million for sham mental and behavioral health services, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina. In addition to defrauding Medicaid, Victoria Finney Brewton, 37, also pleaded guilty to stealing a therapist’s identity to commit the fraud and to filing a false tax return.
U.S. Attorney Tompkins is joined in making today’s announcement by North Carolina Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Division (MID); Roger A. Coe, Acting Special Agent in Charge of the FBI, Charlotte Division; Jeannine A. Hammett, Special Agent in Charge of the Internal Revenue Service, Criminal Investigation Division (IRS-CI); and Derrick Jackson, Special Agent in Charge, Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region.
Brewton pleaded guilty today before U.S. Magistrate Judge David Keesler to seven counts of health care fraud and health care fraud conspiracy, one count of aggravated identity theft, and one count of filing a false tax return. At today’s plea hearing, the defendant admitted that from 2008 to 2012, Brewton, her co-defendant Linda Radeker, also of Shelby, and others submitted in excess of $8 million in false claims to Medicaid. According to filed court documents and statements made in court, Brewton operated a series of after-school and summer childcare programs in Shelby. Brewton recruited juvenile Medicaid recipients to her childcare programs by promising that the program would be free for Medicaid recipients. After Brewton obtained the children’s and families’ Medicaid recipient numbers, she used this information to fraudulently bill Medicaid for mental and behavioral health services that were never provided.
According to the criminal information, Brewton was not licensed or qualified to provide mental and behavioral health services, and she was not approved by Medicaid. Instead, Brewton enlisted the assistance of other complicit Medicaid-approved providers, such as Linda Radeker and, in other instances, stole the identity of Medicaid-approved providers in order to accomplish the fraud. Court documents indicate that Brewton conspired with Radeker, a licensed professional counselor enrolled with North Carolina Medicaid, to submit claims to Medicaid making it appear that Radeker had provided the claimed mental and behavioral health services when, in fact, Radeker did not provide any of the services. Radeker and Brewton then split the Medicaid payments 50/50 for these false claims.
Filed documents also indicate that Brewton hired licensed therapist K.S.M. in October 2010 to provide services at Brewton’s company, Healing Hearts. Although K.S.M. provided some mental and behavioral health services while she worked at Healing Hearts, Brewton submitted false and fraudulent claims to Medicaid through K.S.M.’s Medicaid provider number far in excess of the services actually provided by K.S.M. In or about October 2011, K.S.M. left Healing Hearts after learning that Brewton had submitted false claims through K.S.M.’s Medicaid provider number. Thereafter, Brewton misappropriated K.S.M.’s identity, specifically her Medicaid provider number, in order to continue to submit fraudulent claims to Medicaid after K.S.M. was no longer employed at Healing Hearts. Specifically, the defendant admitted that on or about October 27, 2011, Brewton submitted an Electronic Funds Transfer Authorization Agreement to Medicaid directing that reimbursements for claims submitted through K.S.M.’s provider numbers be deposited into a bank account held and controlled by Brewton. From in or about April 2011 to May 2012, Brewton submitted in excess of $1.8 million in false claims through K.S.M.’s provider number which K.S.M. did not provide. According to court documents, Brewton also misused the Medicaid provider numbers of other therapists employed by her companies in order to submit false claims to Medicaid through their numbers.
As part of her plea, Brewton also admitted that she defrauded the United States by filing a false tax return for the year 2009 that intentionally failed to report the income Brewton received from her scheme to defraud Medicaid. She also failed to file tax returns for 2010 and 2011, which further masked the income from her fraud scheme. Brewton agreed to forfeit a 2005 Dodge Magnum which was seized as the proceeds of fraud during the investigation.
Brewton, who was released on bond, faces a mandatory two years in prison consecutive to any other term of imprisonment and a $250,000 fine for the aggravated identity theft charge, a maximum term of 10 years in prison, and a $250,000 fine for the health care fraud charges; and a maximum term of three years in prison and a $250,000 fine for the filing of a false tax return charge. In her plea agreement, Brewton has agreed to pay full restitution to Medicaid for any losses resulting from her criminal scheme. The final restitution amount will be determined by the court at Brewton’s sentencing hearing, which has not been scheduled yet.
Radeker pleaded guilty to charges of health care conspiracy and money laundering on September 13, 2012, and is awaiting sentencing.
The investigation into Brewton was handled by the FBI, MID, IRS, and HHS-OIG. Special assistance to the task force was provided by the North Carolina Division of Medical Assistance, Program Integrity Section. The prosecution was handled by Assistant U.S. Attorneys Kelli Ferry and Jenny Grus Sugar of the U.S. Attorney’s Office in Charlotte.
The investigation and charges are the work of the Western District’s joint Health Care Fraud Task Force. The task force is multi-agency team of experienced federal and state investigators, working in conjunction with criminal and civil Assistant United States Attorneys, dedicated to identifying and prosecuting those who defraud the health care system, and reducing the potential for health care fraud in the future. The task force focuses on the coordination of cases, information sharing, identification of trends in health care fraud throughout the region, staffing of all whistleblower complaints, and the creation of investigative teams so that individual agencies may focus their unique areas of expertise on investigations. The task force builds upon existing partnerships between the agencies, and its work reflects a heightened effort to reduce fraud and recover taxpayer dollars.
U.S. Attorney Tompkins is joined in making today’s announcement by North Carolina Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Division (MID); Roger A. Coe, Acting Special Agent in Charge of the FBI, Charlotte Division; Jeannine A. Hammett, Special Agent in Charge of the Internal Revenue Service, Criminal Investigation Division (IRS-CI); and Derrick Jackson, Special Agent in Charge, Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region.
Brewton pleaded guilty today before U.S. Magistrate Judge David Keesler to seven counts of health care fraud and health care fraud conspiracy, one count of aggravated identity theft, and one count of filing a false tax return. At today’s plea hearing, the defendant admitted that from 2008 to 2012, Brewton, her co-defendant Linda Radeker, also of Shelby, and others submitted in excess of $8 million in false claims to Medicaid. According to filed court documents and statements made in court, Brewton operated a series of after-school and summer childcare programs in Shelby. Brewton recruited juvenile Medicaid recipients to her childcare programs by promising that the program would be free for Medicaid recipients. After Brewton obtained the children’s and families’ Medicaid recipient numbers, she used this information to fraudulently bill Medicaid for mental and behavioral health services that were never provided.
According to the criminal information, Brewton was not licensed or qualified to provide mental and behavioral health services, and she was not approved by Medicaid. Instead, Brewton enlisted the assistance of other complicit Medicaid-approved providers, such as Linda Radeker and, in other instances, stole the identity of Medicaid-approved providers in order to accomplish the fraud. Court documents indicate that Brewton conspired with Radeker, a licensed professional counselor enrolled with North Carolina Medicaid, to submit claims to Medicaid making it appear that Radeker had provided the claimed mental and behavioral health services when, in fact, Radeker did not provide any of the services. Radeker and Brewton then split the Medicaid payments 50/50 for these false claims.
Filed documents also indicate that Brewton hired licensed therapist K.S.M. in October 2010 to provide services at Brewton’s company, Healing Hearts. Although K.S.M. provided some mental and behavioral health services while she worked at Healing Hearts, Brewton submitted false and fraudulent claims to Medicaid through K.S.M.’s Medicaid provider number far in excess of the services actually provided by K.S.M. In or about October 2011, K.S.M. left Healing Hearts after learning that Brewton had submitted false claims through K.S.M.’s Medicaid provider number. Thereafter, Brewton misappropriated K.S.M.’s identity, specifically her Medicaid provider number, in order to continue to submit fraudulent claims to Medicaid after K.S.M. was no longer employed at Healing Hearts. Specifically, the defendant admitted that on or about October 27, 2011, Brewton submitted an Electronic Funds Transfer Authorization Agreement to Medicaid directing that reimbursements for claims submitted through K.S.M.’s provider numbers be deposited into a bank account held and controlled by Brewton. From in or about April 2011 to May 2012, Brewton submitted in excess of $1.8 million in false claims through K.S.M.’s provider number which K.S.M. did not provide. According to court documents, Brewton also misused the Medicaid provider numbers of other therapists employed by her companies in order to submit false claims to Medicaid through their numbers.
As part of her plea, Brewton also admitted that she defrauded the United States by filing a false tax return for the year 2009 that intentionally failed to report the income Brewton received from her scheme to defraud Medicaid. She also failed to file tax returns for 2010 and 2011, which further masked the income from her fraud scheme. Brewton agreed to forfeit a 2005 Dodge Magnum which was seized as the proceeds of fraud during the investigation.
Brewton, who was released on bond, faces a mandatory two years in prison consecutive to any other term of imprisonment and a $250,000 fine for the aggravated identity theft charge, a maximum term of 10 years in prison, and a $250,000 fine for the health care fraud charges; and a maximum term of three years in prison and a $250,000 fine for the filing of a false tax return charge. In her plea agreement, Brewton has agreed to pay full restitution to Medicaid for any losses resulting from her criminal scheme. The final restitution amount will be determined by the court at Brewton’s sentencing hearing, which has not been scheduled yet.
Radeker pleaded guilty to charges of health care conspiracy and money laundering on September 13, 2012, and is awaiting sentencing.
The investigation into Brewton was handled by the FBI, MID, IRS, and HHS-OIG. Special assistance to the task force was provided by the North Carolina Division of Medical Assistance, Program Integrity Section. The prosecution was handled by Assistant U.S. Attorneys Kelli Ferry and Jenny Grus Sugar of the U.S. Attorney’s Office in Charlotte.
The investigation and charges are the work of the Western District’s joint Health Care Fraud Task Force. The task force is multi-agency team of experienced federal and state investigators, working in conjunction with criminal and civil Assistant United States Attorneys, dedicated to identifying and prosecuting those who defraud the health care system, and reducing the potential for health care fraud in the future. The task force focuses on the coordination of cases, information sharing, identification of trends in health care fraud throughout the region, staffing of all whistleblower complaints, and the creation of investigative teams so that individual agencies may focus their unique areas of expertise on investigations. The task force builds upon existing partnerships between the agencies, and its work reflects a heightened effort to reduce fraud and recover taxpayer dollars.
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