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 fraud-abuse-
reporting@ag.state.oh.us 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.
3
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:
4
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
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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, Warner-
Lambert 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,
9
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
Restitution
Person Convicted Employer Provider Type County Offense Allegation Ordered Sentence
Independent home Billing for services

Adrienne Foster health provider Franklin Medicaid Fraud not rendered $708.00 6 months probation
5 yrs. probation, & 500

Pamela Laury Mother of recipient Franklin Medicaid Fraud Filled out false claims $3,000.00 hrs. community service
Stole & used resident 2 years community
Erica McElroy Inn at Lakeview Employee of facility Franklin Credit Card Theft credit card control
$ 410.27 - to be
Manor Care of Theft, Credit Card Stole & Used resident paid jointly with
Michelle Smith Lakeshore Employee of facility Cuyahoga Misuse & Forgery ATM card co-defendant 1 year probation
Hired Independent
Provider & Instructed
to bill for services not
William Springhart Father of recipient Franklin Medicaid Fraud rendered $1,200.00
Left resident
unattended on the
McCrea Manor toilet and she fell off
Nursing & Rehab. sustaining fractured 10 days jail & 10 days
Sandra Teapole Center Nurse aide Stark Patient Neglect ribs and lower spine community service
$55,028.31
(Medicare)
$2,449.28
(Medicaid) joint
and several
Cardiodiagnostic Making a False Billed for services not liability w/R.
Services Diagnostic Lab Franklin Statement rendered Jones 5 years probation
Stole money from

nursing home
resident trust
Edgewood Manor Office Business accounts and forged 3 years probation & 100
Jeri Chini Nursing Home Manager Ottawa Theft signatures on checks $64,014.92 hrs. community service
15
Attachment B
Restitution
Making a False
Statement Relating
Cardiodiagnostic Vice-president and to a Health Care Billed for services not $2,438.40 - 3 years probation & 25
Connie Jones Services co-owner Franklin Matter rendered Medicare hours community service
$2,499.28 -
Medicaid,
$52,589.91 -
Medicare/joint
and several 3 years probation, 6
Cardiodiagnostic President and co- Making a False Billed for services not liability with months house arrest, 25
Richard Jones Services owner Franklin Statement rendered corp. hours community service
Forged receipt claims

Sunbridge Care & Theft from the against patient fund
Lionel Bertie Rehabilitation Activity Assistant Lucas Elderly accounts. 1 year in prison
Administered
laxatives to patients
in order to make
Willowood Care things difficult for the
Kim Moenich Center of Brunswick L.P.N. Medina Patient Abuse day shift 10 months in prison
5 years community
Part-owner of Billing for fictitious control & 100 hrs.
Brian Hathaway company Franklin Medicaid Fraud ambulette runs $142,881.90 community service
Wexner Heritage Employee of nursing Stole money from a
Gracie Wellman Village home Franklin Theft resident's room
5 years community
Billing for services control, 50 hours
Lori Levy New Dimensions, Inc. Business owner Franklin Medicaid Fraud not rendered $95,000.00 community service
Bradley Road Nursing Struck resident with 40 hours com-munity
Madolyn Gilles Home L.P.N. Cuyahoga Assault her fist service
16
Attachment B
Restitution
Nurse aide failed to

place required mat
Failure to Provide beside bed and
Care to a resident fell sustained 1 year probation, 40
Isabelle Ridgeway Functionally a laceration on his hours community service
Lawrence Weekes Center Nurse aide Franklin Impaired Person forehead & court costs
Billing for services 3 years community
Jeffrey Bates Golden Age Mobility Partner in business Trumbull Medicaid Fraud not rendered $30,335.37 control
Lied on job
application about his
felony record & billed
for services not
Jonathan Crutchfield Community Support Home health aide Hamilton Medicaid Fraud provided $6,500.00 7 months prison
Billed for skilled
nursing and daily 11 months prison,
living services not suspended, 5 years
Cheryl Denney R.N. Franklin Medicaid Fraud rendered. $54,480.00 community control
Billing Medicaid for
services while having Ordered to pay
Unlicensed Practice an expired nursing restitution by November
Lora Gregory L.P.N. Franklin of Nursing license $1,564.80 10, 2005
Filled pre-scriptions
and billed Medicaid
using a recipient's
Drug trafficking & name, then gave 3 years com-munity
Tampering with prescriptions to his control, 200 hours
Charlie Haddad CVS Pharmacy Pharmacy tech Cuyahoga Records brother community service
Brother filled
prescriptions and
billed Medicaid using
a recipient's name 3 years com-munity
then they were given control, 200 hours
Ramie Haddad CVS Pharmacy None Cuyahoga Drug Possession to him community service
17
Attachment B
Restitution
10 months jail
Stole check from suspended, 6 months
resident's room and "home incarceration" at a
Theft from the deposited it into her halfway house, 2 years
Cherise Haynes Valley View Nursing Nurse aide Summit Elderly bank account community control
Bank Fraud &
Guardian Health Making a False Billing for services 37 months in federal
Michelle Hunter Services Business Owner Cuyahoga Statement not rendered $32,951.70 prison
Billing for services 3 years community
Johnna Koch Home health aide Franklin Medicaid Fraud not rendered $13,071.00 control
Independent home Billing for services 6 months, suspended, 3

Tawanda Laws health provider Franklin Medicaid Fraud not rendered $804.00 years probation
30 days jail, 60 days
house arrest, 5 years
community control &
Punched resident in 500 hrs.community
Chad Clay Van Wert Manor Nurse aide Van Wert Patient Abuse the mouth service
Grabbed and twisted 1 year jail suspended, 5

resident arm leaving years probation & cannot
Anita Howe Carlton Manor Nurse aide Fayette Patient Abuse hand-print bruises work in nursing
Hit one resident and Six months suspended, 2

picked up another years community control
resident and dropped & 40 hrs. community
Weldon Smoot Nurse aide Fayette Patient Abuse him into his bed service
Threw resident into a 60 days jail suspended, 2

wheelchair forcefully years probation,
and caused a 3-4" surrender nursing
Shari Boric Mercy Franciscan L.P.N. Butler Patient Neglect scratch on her arm license
18
Attachment B
Restitution
Illegal Processing of Forged prescriptions

Drug Docu-ments, for Oxycontin and
Attempted filled them using 12 months in jail, 5 years
Jennifer Stetka Stetka Prescriptions None Geauga Possession of Drugs Medicaid cards community control
30 days jail, 3 years

Independent home Billing for services community control, drug
Hetty Cruz health provider Franklin Medicaid Fraud not rendered $26,188.50 and alcohol screenings
Billed for services not

rendered and
manipulated claims
Natalie Mauldin, resulting in a higher 180 days jail suspended,
L.P.N. Home health nurse Franklin Medicaid Fraud reimbursement rate $1,537.00 1 year probation
Sold physician drugs

Sale of Unapproved which were not yet 6 months, suspended, 2
Robert Koehler None Franklin Drugs FDA approved. years probation
Persistent Struck resident in the

Dorothy Austin Shawnee Manor Nurse aide Allen Disorderly Conduct chest 30 days, suspended
6 months in jail,
O'Brien Memorial Forcefully struck a suspended, 2 years
Anita Craig Health Center Nurse Aide Trumbull Assault resident in the head probation
Billing for services to
family member,
making false and
Independent home misleading 5 years supervision, pay
Debbie C. Belle health provider Franklin Medicaid Fraud statements $50,497.50 cost of supervision
Sheila Breckenridge, Forgery, Medicaid Billing for services 3 years com-munity
L.P.N. L.P.N. Franklin Fraud not provided $20,564.70 control
Health Care Fraud, Provided used $58,200.00 (HCF),

Bankruptcy Fraud wheelchairs but billed $79,022.00 (TE), 51 months in prison, 3
Michael Frantz Medi Care Orthopedic Business owner Lucas and Tax Evasion for new wheelchairs $14,736.00 (BF) years supervised release
19
Attachment B
Restitution
Billing for services

Jan Halicki Home health aide Franklin Medicaid Fraud not rendered $18,500.00 3 years probation
Billing for transports 5 years com-munity

Skill Care of ambulatory control, 4 years
James Sutton Transportation Business owner Franklin Medicaid Fraud individuals $132,838.67 suspended
Accepted kickbacks
for services not
rendered and caused
false billings to be 5 years com-munity
Beth Forward Mother of recipient Franklin Medicaid Fraud submitted $67,854.50 control
Billed both Medicaid

and private insurers
and kept money from
Rajiv Taneja, D.M.D. Dentist Franklin Medicaid Fraud both $12,500.00
3 years community con-

Theft, Aggravated trol, 200 hrs. community
Theft with Elderly service, drug testing,
Renaissance Spec, Forgery with Stole checks from attend AA mtgs., drug
Lavenna Todd Retirement Nurse aide Cuyahoga Elderly Spec resident $700.00 treatment
6 months prison, 3 yrs.
community control, 40
hrs. community service,
Slapped resident surrender nurse aide
Raymond Crabtree Carlton Manor Nurse aide Fayette Patient Abuse across the face license
LPN gave laxative to
patients to create diffi-
Willowood Care culties for the day
Sue Mejak Center Nurse aide Medina Patient Abuse shift 10 months in prison
20
Attachment B
Restitution
3 years community
control, drug testing, no
employment in health
care facility, court costs,
Manor Care Health Assault, Patient Slapped resident on probation supervision
Darnell Sims Services Nurse aide Cuyahoga Abuse the face and hand costs
Stole prescriptions
Medicaid Fraud, from his doctor and
Illegal Processing of had them filled using
Zebulun Balas Recipient Wayne Drug Documents, his Medicaid card 2 years probation
Joseph R. Evans Home health aide Franklin Medicaid Fraud not rendered $12,000.00
Independent home Billing for services

Melanie Wallerick health provider Franklin Medicaid Fraud not rendered $16,667.00 6 months jail, suspended
10 days in jail, sus-
Nelson Park Care Struck resident in the pended, 6 months
Angeline Jamar Center Nurse aide Franklin Patient Neglect chest repeatedly probation
Struck resident's
Arlington Nursing cheek with the palm 6 months probation,
Cheryl Thompson Home Nurse aide Franklin Assault of her hand court costs
6 months suspended, 2
years community
Punched a resident in control, 100 hours
Afrique Wallace Somerset Point Nurse aide Cuyahoga Patient Abuse the jaw community service
Hit resident on the
left side of his face
James Wuellah Bryden Place Nurse aide Franklin Patient Neglect with an open hand 1 year probation
Billing for services 6 months suspended, 5
Debbie Fleming Home health aide Franklin Medicaid Fraud not rendered $4,824.00 years probation
6 months house arrest,
Transportation of $120,000.00 100 hours community
Co-owner of ambulatory (jointly w/co- service, 3 years
Edward Seleznyov business Cuyahoga Health Care Fraud individuals defendants) probation
21
Attachment B
Restitution
6 months suspended on
condition of no new con-
Billing for services victions for 2 years, court
Sherry Stenger Home health aide Franklin Medicaid Fraud not rendered $972.00 costs
Meadow Wood Care Public Indecency Exposed penis to
Carl Roehm Center Nurse aide Brown (misdemeanor) resident 1 year probation
Billed for home
health services not
provided, hired
someone who is not a
Indepen-dent home provider to work in
Sherry Clark health provider Franklin Theft her place $2,664.00 1 year probation
90 days jail, suspended if

Indepen-dent home Billing for services fine and restitution are
Phyllis Edwards health provider Franklin Medicaid Fraud not rendered $2,036.40 paid by 12/292/06
Deception to Obtain Used false

Drugs, Deception to prescriptions to
Obtain Drugs, obtain drugs using
Brent Keim Medicaid recipient Hardin Medicaid Fraud his Medicaid number $6,170.00 10 months in jail
Billing for the

Concord transportation of 18 months in prison, 2
Boris Malahimov Transportation, Inc. Owner of business Cuyahoga Health Care Fraud ambulatory patients $120,001.00 years super-vised release
$400,000.00 (joint
Contact Express Co-owner of Billing for services with co- 8 months in prison, 2
Igor Murin International business Cuyahoga Health Care Fraud not rendered defendants) years pro-bation
6 months in prison, 6
months home
confinement
Transportation of (w/electronic
Co-owner of ambulatory $120,000.00 (joint monitoring), 3 years
Lev Musaelyants Lana's Transportation business Cuyahoga Health Care Fraud individuals w/co-defendants) probation
22
Attachment B
Restitution
3 years pro-bation with 6

Transportation of months home
Co-owner of ambulatory $30,000.00 (joint confinement (electronic
Paul Musaelyants Lana's Transportation business Cuyahoga Health Care Fraud individuals w/co-defendants) monitoring)
Contact Express Co-owner of Conspiracy, Health Billing for services $400,000.00 (joint 20 months in prison, 2
Mikhail Rustamov International business Cuyahoga Care Fraud not rendered w/co-defendants) years probation
Contact Express Co-owner of Billing for services $120,000.00 (joint 8 months in prison, 2
Emil Shnartsman International business Cuyahoga Health Care Fraud not rendered w/co-defendants) years supervised release
Katrina Harris L.P.N. Franklin Medicaid Fraud not rendered $664.60
90 days jail suspended,

180 days community
control during which
Billing for services time she is to make full
Shirelle McClure L.P.N. Franklin Medicaid Fraud not rendered $3,181.40 restitution
3 years pro-bation, 6
Transporting and months home
billing for patients confinement
Mikhail Perkis Sun Arrow, Inc. Business owner Franklin Health Care Fraud that are ambulatory $120,000.00 w/electronic monitoring
Contact Express Billing for services
Yuriy Romanov International Business owner Franklin Health Care Fraud not rendered $200,000.00 8 months in prison
Witness Stomped on resident's 2 years community
Jean Mitchell Pleasant Care Center Nurse aide Summit Intimidation hand control
1 year community
control, basic
supervision, costs of
prosecution &
Billing for services supervision, 40 hours
Jennifer Baker Home health aide Franklin Medicaid Fraud not rendered $6,100.00 community service
23
Attachment B
Restitution
5 years community
control, 200 hours
community service,
Tampering with alcohol and drug testing,
Evidence, Theft Stole cash from restitution, supervision
Daisy Washington Pleasant Care Center Employee Cuyahoga w/Elderly Spec resident $360.00 fee
90 days jail suspended,

Billing for services 180 days community
Shirelle McClure Home health nurse Franklin Medicaid Fraud not rendered $3,181.40 control, and court costs
24
Attachment C
WORKERS' COMPENSATION FRAUD UNIT CONVICTIONS IN CALENDAR YEAR 2005
Restitution
Person Convicted Employer Type County Offense Allegation Ordered Sentence
Breininger, Robert Claimant Lucas Falsification Falsification Capias

30 Days Suspended for 1
Empire Failure to Failure to Pay Year Probation and Fine
Nicolette, Ray Environmental Employer Columbiana Comply BWC Premiums $0.00 $500
Workers'
Compensation Working While 5 Years Community Control
Pascoe, Charlotte Claimant Franklin Fraud Receiving $12,730.19 and Restitution
Forged his dead

mother's
signature and
cashed widow 12 Months Incarceration,
Cole, Calvin Sr. Claimant Mahoning Theft benefit warrants. $24,555.00 Court Costs and Restitution
Tower Building Failure to Failure to Pay Fine, Costs $57.00, Sheriff

Helberg, Richard Services Employer Lucas Comply BWC Premiums $0.00 Fees $18.00

Speciality Pie Failure to Failure to Pay Years Probation, Fine $150
Dennison, Leonard Bakers Employer Knox Comply BWC Premiums $0.00 and Court Costs
Failure to Failure to Pay

Pignotti, Michael Basil's Café Employer Ashtabula Comply BWC Premiums $0.00 Fine

Pignotti, Michael Basil's Café Employer Ashtabula Comply BWC Premiums $0.00 Fine
25
Attachment C
Restitution
Illegal
Processing of
Drug Docs,
Workers'
Compensation
Fraud, Engaging in a Fine $2,000, Court Costs, 3
Tampering Pattern of Years Probation, 300 Hours
Weaver, Carla Westside Medical Provider Cuyahoga w/Records Corrupt Activity $0.00 Community Work Service
30 Days Jail Time

Infinet Training & Failure to Failure to Pay Suspended, Fine and
Griffith, Adam Technologies Employer Coshocton Comply BWC Premiums $327.97 Restitution

Flake, William WE Products, Inc. Employer Guernsey Comply BWC Premiums $0.00 Fine & Costs
Failure to Failure to Pay Fine $100 and Court Costs

Straker, Joel Straker Trucking Employer Logan Comply BWC Premiums $0.00 $77
90 Days Jail Suspended,

Spring Valley Failure to Failure to Pay Court Costs $95 and
Thompson, Todd Development Inc. Employer Greene Comply BWC Premiums $31,024.54 Restitution
Erickson's Family Failure to Failure to Pay 90 Days Suspended, 5 Years

Shuster, Todd Restaurant Employer Wood Comply BWC Premiums $0.00 Probation
Fine, 30 Days Suspended, 1

Year Probation - Condition:
Failure to Failure to Pay Pay Employer Premiums
Cooper, Raymond Pataskala Paving Claimant Franklin Comply BWC Premiums $104,005.40 Due
26
Attachment C
Restitution
6 Months Jail, w/90 Days

Suspended, 91 Days Jail
Time Credit, 2 Years
Community Control (1 Yr.
Workers' Reporting/1 Yr. Non-
Compensation False Claim; Reporting), Court Costs and
Arreguin, Salvador Claimant Franklin Fraud Falsification $15,026.00 Restitution
Forged and
Workers' cashed deceased
Compensation claimant's BWC 1 Year Community Control
Berry, Mozelle T. Claimant Franklin Fraud checks. $947.90 and Restitution
Workers'
Goodroe, Charles Claimant Franklin Fraud Receiving $29,032.24 and Restitution
Failure to Failure to Pay Fine and 12 Months

Nolan, George S. Siverre Inc. Employer Muskingum Comply BWC Premiums $0.00 Probation

Years Probation, 80 Hours
Failure to Failure to Pay Community Service,
Miller, Kenneth JIT Pallets Employer Columbiana Comply BWC Premiums $47,698.97 Restitution and Fine
Attempted
Workers'
Compensation Working While 1 Year Probation and
Lowe, Shirlene Claimant Franklin Fraud Receiving $3,000.00 Restitution
303 Sand & Failure to Failure to Pay Jail Time Suspended and
Stuble, Karl H. Gravel Employer Portage Comply BWC Premiums $0.00 Court Costs $62
27
Attachment C
Restitution
Workers' 6 Months Incarceration

Compensation Working While Suspended for 5 Years
May, William Jr. Claimant Franklin Fraud Receiving $6,285.39 Probation and Restitution
6 Months Suspended for 5

Workers' Years Probation, Restitution,
Compensation Working While Court Costs, Investigative
Hileman, Robert Claimant Franklin Fraud Receiving $7,000.00 Costs
Fine $100.00 Suspended, 60

Days Jail Sentence
Spitler's Family Failure to Failure to Pay Suspended and 80 Hours
Appis, Travis P. Restaurant Employer Coshocton Comply BWC Premiums $0.00 Community Service
Workers'
Compensation Working While 30 Days Suspended, Fine
Crawford, Bryan Claimant Franklin Fraud Receiving $2,781.16 Court Costs and Restitution

Sulzer, Louis Jr. CAI Trucking Employer Cuyahoga Comply BWC Premiums $0.00 Fine and Costs
Workers'
Compensation Working While Fine, Court Costs and
Hall, Lowell Claimant Franklin Fraud Receiving $11,685.75 Restitution
Workers'
Compensation Working While 5 Years Community Control,
Ferenz, Gerhard F. Claimant Franklin Fraud Receiving $5,941.41 Fine and Restitution

Scherkoske, Sharon Tana Corporation Employer Lucas Comply BWC Premiums $0.00 Court Costs $79.00 and Fine
28
Attachment C
Restitution
Workers' 14 Months Incarceration (6

Compensation Working While Mon. Served w/8 Mo. Left
Guilfoil, Stephen Claimant Franklin Fraud Receiving $98,511.31 to serve) and Restitution

Mullen, William Xpress Print Inc. Employer Stark Comply BWC Premiums $0.00 Fine and Court Costs
Failure to Failure to Pay 30 Days Suspended, Fine

Mullen, William Xpress Print Inc. Employer Hancock Comply BWC Premiums $0.00 and Court Costs
Fine, Court Costs, 30 Days

Suspended for 6 Months
Failure to Obstructing $4,000.00 Probation and $15,000.00
Moore, Corbin Westside Medical Provider Cuyahoga Report Felony Justice Forfeiture Forfeiture
Workers' 10 Months Prison,

Compensation Working While Restitution and Court Costs
Olasky, Joseph Claimant Franklin Fraud Receiving $20,608.85 $273.10
4 Months Suspended
Workers' Incarceration for 2 Years
Compensation Working While Community Control and
Hotzler, Barry Claimant Franklin Fraud Receiving $1,720.00 Restitution
Workers' Fine, Court Costs, 12

Compensation Working While Months Non-Reporting
Queen, Gary L. Claimant Franklin Fraud Receiving $2,870.81 Probation
Workers'
Compensation Working While
Torok, Mark Claimant Franklin Fraud Receiving $4,121.77 6 Days Jail Time
29
Attachment C
Restitution
180 Days Incarceration

Workers' Suspended for 1 Year
Compensation Working While Probation, Court Costs and
Lee, Marie Claimant Franklin Fraud Receiving $724.86 Restitution
Working while
receiving and
failure to notify
the BWC of
Workers' claimant's receipt 180 Days Suspended, 2
Compensation of unemployment Years Probation, Fine and
Wright, Marty Claimant Franklin Fraud benefits. $5,826.85 Investigative Costs
Blockbuster Failure to Failure to Pay

Mozzochi, Barbara E. Construction LTD Employer Columbiana Comply BWC Premiums $0.00 Fine
Delaware
Maintenance Failure to Failure to Pay
Banks, Wendy L. Company Employer Delaware Comply BWC Premiums $0.00 Fine and court Costs
Workers' 6 Months Suspended for 3

Compensation Working While Years Probation, Fine, Court
Buck, Richard Claimant Franklin Fraud Receiving $4,178.00 Costs and Restitution
5 Years Community
Workers' Control, Court Costs, $60.00
Compensation Working While Supervision Fee and
Dillon, Ronald Claimant Franklin Fraud Receiving $24,999.28 Restitution
30
Attachment C
Restitution
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, Forfeit Bank Account - 3
Lover, Thomas Scott Money Services Not Years Incarceration and
DC Westside Medical Provider Cuyahoga Laundering Rendered $191,000.00 Restitution
American Scrap
Tire Recyclers Failure to Failure to Pay
Schroll, Sanford dba Perfect Mulch Employer Ashtabula Comply BWC Premiums $0.00 Fine
Workers'
Compensation Working While 6 Months Suspended for
Fejes, Michael Claimant Franklin Fraud Receiving $9,994.32 Repayment of Restitution
Workers' 10 Days Incarceration
Compensation Working While Suspended, Fine and Court
Bugala, Michael A. Claimant Franklin Fraud Receiving $5,045.14 Costs
Attempted
Workers' 3 Months Suspended
Compensation Incarceration, Fine and
Stumpff, James E. Claimant Montgomery Falsification Fraud (M1) $0.00 Court Costs
Fine $100 and Costs, 10 Days
Failure to Failure to Pay Jail Suspended, 12 Months
Bailey, Michael Bailey's Café Employer Guernsey Comply BWC Premiums $0.00 Supervision
31
Attachment C
Restitution
Workers' 3 Years Community Control,

Compensation Working While Restitution and Investigative
Evans, Robert F. Claimant Franklin Fraud Receiving $2,469.71 Costs
Compensation Working While Suspended, Court Costs and
Hanks, Todd Claimant Franklin Fraud Receiving $11,500.00 Restitution
Compensation Working While Investigative Costs and
Anania, Roxanne Claimant Franklin Fraud Receiving $12,159.48 Restitution
Grand Theft and $47,909.12 2 Years Incarceration and

Kinnen, Stephanie Westside Medical Provider Cuyahoga 7 Other Charges SNR Forfeiture Court Costs
3 Months Incarceration
Workers' Suspended for 3 Years
Compensation Working While Probation, Restitution and
Ward, Jacqueline Claimant Franklin Fraud Receiving $7,378.76 Court Costs
Forged and 6 Months Incarceration

Workers' cashed deceased Suspended, Restitution, 80
Compensation mother's Widow Hours Community Service
Blake, Carol J. Claimant Franklin Fraud Death warrants. $5,731.74 and Court Costs
Receiving Stolen Forged a stolen 30 Days Jail Suspended,

Marston, Meadow Claimant Franklin Property warrant $50.00 Court Costs and Restitution
Theft of BWC 5 Years Community Control
Shannon, Melissa Claimant Franklin Theft warrant $226.00 and Restitution
Workers' Submitted False

Compensation and Misleading
Kinney, William Claimant Franklin Fraud Job Search Forms Abated by death.
Workers' 1 Year Community Control,

Compensation Working While 80 Hrs. Community Service
Allen, John Claimant Cuyahoga Fraud Receiving $33,107.15 and Fine
32
Attachment C
Restitution
Wayne's Truck Failure to Failure to Pay 30 Days Jail Time

Hedglin, Wayne A. II and Auto Repair Employer Trumbull Comply BWC Premiums $0.00 Suspended and Fine $100
Gabel Masonry Failure to Failure to Pay
Gabel, Jack Inc. Employer Medina Comply BWC Premiums
6 Months Jail Suspended for
Workers' 4 Years Probation, 8 Days
Alphabet, Marshamelle Compensation Working While Jail Time Credit and
N. Claimant Franklin Fraud Receiving $4,722.74 Restitution
Workers'
Compensation 6 Months Incarceration
Smith, Joshua Claimant Franklin Fraud False Claim $0.00 Suspended and Court Costs
Workers'
Bayer, Dennis Claimant Franklin Fraud Receiving $30,858.28 Court Costs and Restitution
Workers'
Gibson, William Claimant Franklin Fraud Receiving $9,972.00 and Restitution
Monroe, Timothy Claimant Champaign Comply BWC Premiums $0.00 Fine $35.00 and Court Costs
Attempted
Workers'
Routh, Robert C. Claimant Erie Fraud Receiving $30,000.00 Court Costs and Restitution

Compensation Working While Court Costs, Restitution and
Favret, Thomas W. Claimant Franklin Fraud Receiving $11,393.71 22 Days Jail Time Credit
6 Months Suspended, 3
Years Community Control,
27 Days Jail Time Credit and
Henricks, Richard Claimant Franklin Forgery False Claim $250.00 Restitution
33
Attachment C
Restitution
Shamrock Workers'
Inspection & Loss Compensation Failure to Pay Court Costs of $267.00 and
Devine, Jennifer Control Employer Franklin Fraud BWC Premiums $0.00 Fine
Bishop Motor Failure to Failure to Pay 60 Days Suspended, 1 Year
Bishop, Tom Car, Inc. Employer Licking Comply BWC Premiums $0.00 Probation and Fine
Dor Mar Heating

and Air Failure to Failure to Pay 3 Years Probation, Court
Fleming, Luann Conditioning, Inc. Employer Licking Comply BWC Premiums $666.00 Costs and Fine
Workers'
Manz, Brian J. Claimant Franklin Fraud Receiving $3,890.00 Court Costs appx. $200
Working While
Workers' Receiving - 5 Years Community Control,
Compensation Failure to Report Restitution, 29 Days Jail
Norton, Dennis A. Claimant Franklin Fraud Wages $38,362.22 Time Credit Granted
90 Days Incarceration, 6
Failure to Altered BWC Months Suspended, Fine
Vance, Larry Larry Vance Co. Claimant Cuyahoga Comply Certificate $0.00 and Court Costs
Attempted Working While 2 Years Community Control

Johnson, George Claimant Cuyahoga Forgery Receiving $3,136.27 and Restitution
Allegedly
withdrawing
BWC funds from
his deceased 6 Months Incarceration,
father's bank $2,500 Fine, Court Costs and
Massey, Frank Claimant Cuyahoga Forgery account. $12,745.00 Restitution
Workers'
Conti, John Claimant Franklin Fraud Receiving $19,577.00 Court Costs and Restitution
34
Attachment C
Restitution
Workers'
Compensation Working While $150 Fine and court Costs,
Yoder, Celia J. Claimant Franklin Fraud Receiving $14,970.30 Sentence Suspended
Altered BWC
Tampering Certificates
w/Records and showing he had
Mueller Tree Failure to BWC Coverage
Mueller, Matthew M. Service Misc. Summit Comply and he did not. $0.00 2 Years Community Control
Workers'
Compensation Working While Court Costs, Restitution Pd.
Young, Charles R. Claimant Franklin Fraud Receiving $2,662.71 Prior to Sentencing

Bidwell, Jim Jim's Auto Service Employer Licking Comply BWC Premiums $0.00 1 Year Probation
Suspended, $150 Fine &
Court Costs Suspended,
Working While Restitution paid prior to
Kelly-Timmins, Tina Claimant Franklin Falsification Receiving $1,646.28 sentencing.
US Dist. Ct. Conspiracy to

Northern Dist. Commit Health Fraudulent
Cousino, Susan D. Medback Clinic Provider Western Div. Care Fraud Billing
Workers'
Compensation
Fraud and Working While
Failure to Receiving/Failur
Weems, Kenneth L. Claimant Franklin Appear e to Appear Dismissed August 4, 2005
35
Attachment C
Restitution
Workers' 40 Hours Community

Compensation Working While Service, Court Costs and
Piar, William C. Claimant Cuyahoga Fraud Receiving $28,856.37 Restitution
Attempted Working While

Santiago, Angela Roman Floors Claimant Cuyahoga Forgery Receiving $0.00 Fine and court Costs
Workers' 6 Months Suspended, 5

Compensation Working While Years Probation, Restitution
Kelley, Julie A. Claimant Franklin Fraud Receiving $4,104.00 to CBS Personnel Services
Workers' Suspended for 2 Years
Fout, Aaron T. Claimant Franklin Fraud Receiving $1,382.40 Restitution
Workers'
Gurish, Mark Claimant Cuyahoga Fraud Receiving $0.00 Fine and Court Costs
Workers' Suspended, 3 Years
Thomas, Russell Claimant Franklin Fraud Receiving $55,136.99 Restitution
Forged 2 BWC
Attempted certificates of 90 Days Incarceration
Forgery and Workers' Suspended for payment of
Failure to Compensation Court Costs and inactive
Zahn, Daniel Claimant Cuyahoga Comply coverage. $17,080.00 probation and Restitution.
36
Attachment C
Restitution
R & J Linger Failure to Failure to Pay Fine, 90 Days Incarceration

Linger, Robert B. Markets Employer Franklin Comply BWC Premiums Suspended, 1 Year Probation
Workers'
Carter, Lavern Claimant Franklin Fraud Receiving $15,596.00 Fine and Restitution
Submitted false $300 Fine, Court Costs,

Workers' job search form Restitution, 120 Days,
Compensation and working suspended if Fine, CC,
Eskins, Sandra G. Claimant Franklin Fraud while receiving. $3,741.25 restitution paid by 9/15/07.
Workers'
Compensation Working While 6 Months Incarceration and
Costilla, Gilberto Claimant Franklin Fraud Receiving $1,184.10 Restitution
Living
Maintenance
Wage Loss
Workers' benefits paid
Compensation when target
Fraud and essentially not 5 Years Community Control,
Aduddell, Keith Claimant Franklin Forgery working. $32,468.63 Court Costs and Restitution

Compensation Working While Suspended for 1 Year
Bozman, Emmanuel L. Claimant Franklin Fraud Receiving $9,358.30 Probation and Restitution
Workers' 30 Days Suspended

Compensation Working While Sentence, Fine, Court Costs
Milillo, Vito Claimant Franklin Fraud Receiving $17,493.80 and Restitution
37
Attachment C
Restitution
Workers'
Compensation Working While 60 Months Community
Maybrier, Harold Claimant Franklin Fraud Receiving $12,169.69 Control and Restitution
Hometown Grills
Inc. aka Failure to Failure to Pay
Kiihr, Timothy Westerville Grille Employer Franklin Comply BWC Premiums $0.00 5 Years Community Control
Apple of God's
Eye Christian Failure to Failure to Pay
Stover, Olive Daycare Employer Franklin Comply BWC Premiums $0.00 Fine/Costs Suspended
Workers' Suspended, 1 Year
Compensation Working While Probation, Court Costs and
McCormack, Lori Claimant Franklin Fraud Receiving $4,517.89 Restitution
Falsifying C-84s
Workers' to get temporary
Compensation total disability 5 Years Community Control,
Bertram, Debora S. Claimant Franklin Fraud benefits. $6,603.11 Restitution and Court Costs
BWC claimant
submitted false
wage information
and
misrepresented
Workers' the status of his
Compensation business in order 5 Years Probation and
Campbell, Mark S. Claimant Franklin Fraud to receive WL. $22,342.86 Restitution
Workers'
Compensation 1 Year Community Control,
Murphy, Delores Claimant Cuyahoga Fraud False Claim $1,648.69 Court Costs and Restitution
38
Attachment C
Restitution

Waldron, Dean Claimant Harrison Comply BWC Premiums $0.00 Fine
Workers' 180 Days Suspended, 2

Compensation Working While Years Probation, Court
Jarmusz, Brenda S. Claimant Franklin Fraud Receiving $1,635.75 Costs and Restitution
11 mos. susp. 5 yrs.

community control, court
costs, investigative costs,
restitution and 100 hrs.
Lambert, Ronald Claimant Franklin Forgery False Claim $845.00 community. service.
5 Years Community Control,

75 Hrs. Community Service,
Working While 63 Days Jail Time Credit and
Blanchard, Anthony Claimant Franklin Forgery Receiving $7,165.02 Restitution
Angelic Failure to Failure to Pay Fine & Court Costs

Manningham, Gail Transporation Employer Cuyahoga Comply BWC Premiums $0.00 Suspended

Compensation Working While Restitution and Investigative
Spadafore, John Claimant Franklin Fraud Receiving $17,622.79 Costs
Botanical Arts
Lawn & Failure to Failure to Pay
Ramsdell, Seth Landscape Employer Lucas Comply BWC Premiums $0.00 Costs $79.00
Mengs Donut Failure to Failure to Pay 30 Days Jail Suspended and

Meng, Alesia L. Shop Employer Lorain Comply BWC Premiums $0.00 Fine
39
Attachment C
Restitution
A deceased
Widow/Death
Benefit recipient's
son forged his
deceased
mother's name
Workers' and cashed BWC
Compensation warrants after her 5 Years Probation and
Lovsey Warren V. Claimant Franklin Fraud death. $14,630.00 Restitution
Workers'
Compensation Working While 25 Hrs. Community Service
Layne, Brian M. Claimant Franklin Fraud Receiving $1,481.14 and Fine
Shawn's Place dba Failure to Failure to Pay Fine $150, Costs $98, 30
Hoeph, Shawn Italiano's Pizza Employer Stark Comply BWC Premiums $0.00 Days Jail Suspended
Failure to
Comply and Fine Suspended, Court Cost
Harlow-Wentland, Tina Passing Bad Failure to Pay Suspended and 6 Months
M. Employer Lucas Checks BWC Premiums $0.00 Probation
Workers' Cashed Deceased

Compensation Claimant's BWC 90 Days Suspended and
Smith, Hattie Claimant Franklin Fraud Checks. $913.82 Restitution
$300.00 Fine Suspended,

Failure to Failure to Pay $60.00 Cost Suspended, 40
Bigelow, Michael J. The Body Shop Employer Lucas Comply BWC Premiums $0.00 Hours. Community Service
Workers' 180 Days Suspended for 3
Compensation Working While Years Community Control
Wilburn, Barry Claimant Franklin Fraud Receiving $4,655.82 and Restitution
40
Attachment C
Restitution
Fine, 90 Days Incarceration

Failure to Failure to Pay Suspended, 2 Years
Seaman, John Louis Sr. Revere Travel Employer Cuyahoga Comply BWC Premiums $0.00 Probation
Workers' 3 Years Probation,
Compensation Investigative. Costs and
Owens, Jerry Claimant Franklin Fraud False Claim $876.03 Restitution
Workers' 6 Months Suspended
Compensation Working While provided court costs are
Whitmore, Genevieve Claimant Franklin Fraud Receiving $4,039.00 paid by 6/1/06.
Workers' 30 Days Jail Suspended
Compensation Working While Pending 2 Years Probation
Camp, Karen Claimant Franklin Fraud Receiving $7,327.00 and Restitution
$1,223,993.91
41
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: fraud-abuse-reporting@ag.state.oh.us
http://www.ag.state.oh.us

2005 Health Care Fraud Repot

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2005 Health Care Fraud Repot

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Ohio

OHIO ATTORNEY GENERAL’S HEALTH CARE FRAUD

Dear Fellow Ohioan:

Very Truly Yours,

Section Page No.

The Health Care Fraud Section ................................................................. 2

Source of MFCU Workload ...................................................................... 3

Medicaid Fraud Control Unit.............................................................. 5

Medicaid Fraud Cases .................................................................... 6

Patient Abuse Cases........................................................................ 8

Workers’ Compensation Fraud Unit.................................................. 10

Workers’ Compensation Fraud Cases.......................................... 10

A – Key Legislation Related to Health Care Fraud.......................... 13

B - Listing of MFCU 2005 Convictions............................................... 15

C- Listing of WCFU 2005 Convictions ............................................... 25

The Ohio Medicaid Program is a state-run program, providing assistance

Health care professionals become Medicaid providers by entering into a

Fraud against the Workers’ Compensation program can occur in many

The Health Care Fraud Section

The Workers’ Compensation Fraud Unit (WCFU) consists of six attorneys

Source of MFCU Workload

The number of potential cases for investigation has grown steadily

In 2005 the MFCU generated Medicaid restitution and penalties of over

Medicaid Fraud Cases

What is Medicaid Fraud? Under ORC 2913.40, Medicaid fraud occurs

The following represent a few cases which were prosecuted in 2005:

Cardiodiagnostic Services’ owners caused Cardiodiagnostic to bill for diagnostic

A Columbus, Ohio licensed practical nurse (LPN) worked as an independent

The MFCU determined Ohio’s share of the Warner-Lambert national settlement

Ohio received $4 million (combined federal/state share) of a national settlement

Patient Abuse Cases

What is Patient Neglect? Patient Neglect occurs when an employee of a

Workers’ Compensation Fraud Unit

Workers’ Compensation Fraud Cases

KEY LEGISLATION RELATED TO THE HEALTH CARE FRAUD

MFCU is authorized to investigate and prosecute Medicaid Fraud,

1995 Section 3721.22 requires a licensed health care professional in a

Independent home Billing for services

5 yrs. probation, & 500

Stole money from

Forged receipt claims

Nurse aide failed to

Independent home Billing for services 6 months, suspended, 3

Grabbed and twisted 1 year jail suspended, 5

Hit one resident and Six months suspended, 2

Threw resident into a 60 days jail suspended, 2

Illegal Processing of Forged prescriptions

30 days jail, 3 years

Billed for services not

Sold physician drugs

Persistent Struck resident in the

Health Care Fraud, Provided used $58,200.00 (HCF),

Billing for services

Billing for transports 5 years com-munity

Billed both Medicaid

3 years community con-

Independent home Billing for services

90 days jail, suspended if

Deception to Obtain Used false

Billing for the

3 years pro-bation with 6

90 days jail suspended,

90 days jail suspended,

Breininger, Robert Claimant Lucas Falsification Falsification Capias