Superseding Indictment Charges Fourteen Individuals with Conspiracy to Commit $30 Million in Healthcare Fraud
U.S. Attorney Kenneth A. Polite announced the return of a 31-count Superseding Indictment against fourteen individuals charging approximately $30,252,906 in Medicare fraud.
Specifically, HENRY EVANS, age 71; MICHAEL JONES, age 46; PAULA JONES, age 45; SHELTON BARNES, age 62; GREGORY MOLDEN, age 60, SUPRENIA WASHINGTON, age 59; ERICA EDWARDS, age 31; ZELLISHA DEJEAN, age 37, LARRY TAYLOR, age 69; CAREN BATTAGLIA, age 49; SHEILA HOPKINS, age 62; and VERINESE SUTTON, age 63, all of New Orleans; and JONATHON NORA, age 28, of River Ridge; and JEFFREY KOON, age 43, of Lockport, were indicted for conspiracy to commit health care fraud, conspiracy to defraud the United States and to receive and pay health care kickbacks, and health care fraud. BARNES was also charged with obstruction of a federal audit.
The Indictment is the second one involving many of the same parties who were originally indicted in March of 2015. Ten individuals and/or companies have already pleaded guilty to charges associated with the original Indictment and a related Bill of Information involving RHONDA MABERRY. In this Superseding Indictment, three new defendants were added including LARRY TAYLOR, DR. GREGORY MOLDEN, and JEFF KOON. TAYLOR is charged only in Count 2, the kickback conspiracy along with MOLDEN, who also is charged with the health care conspiracy and two individual counts of health care fraud. KOON is charged in the health care conspiracy and four individual counts of fraud. MICHAEL JONES and BARNES were also charged with nine and two additional counts of health care fraud, respectively. Additionally, BARNES was also charged with one count of obstructing a federal audit.
This Superseding Indictment is related to the Indictment returned in March 2015, charging LISA CRINEL and others, some of whom have entered guilty pleas. According to the Superseding Indictment, the defendants participated in a criminal organization for the purpose of fraudulently billing Medicare for medically unnecessary home health services for patients who were not homebound. DRS. BARNES, BARNES, EVANS, MOLDEN and MICHAEL JONES, known as “House Doctors,” ordered home health services for Medicare beneficiaries who had no legitimate medical necessity. The House Doctors falsely signed home health orders regardless of the beneficiary’s needs, homebound status, or diagnoses. In return, DRS. BARNES, EVANS, and MOLDEN received monthly payments fraudulently characterized as medical consultant or director fees for which they provided no services other than fraudulently certifying Medicare beneficiaries for unnecessary home health services. Instead of receiving monthly payments from the home health agency, Abide hired PAULA JONES, DR. MICHAEL JONES’ wife and, thereafter, inflated salary payments to PAULA JONES represented MICHAEL JONES’ fees for fraudulently certifying home health for ineligible Medicare beneficiaries. Abide also paid LARRY TAYLOR, MICHAEL JONES’ patient recruiter/driver and, in return, MICHAEL JONES agreed to send Abide Medicare patients for home health.
Marketers contacted JONATHAN NORA and others to confirm that the person fraudulently referred for home health was a Medicare beneficiary. Once NORA determined the referred individual was a Medicare beneficiary, NORA scheduled a physician visit, usually with an Abide House Doctor, well knowing that the individual referral to Abide was by a Marketer, instead of the beneficiary’s own health care professional.
Registered nurses, including EDWARDS, WASHINGTON, DEJEAN, HOPKINS and KOON were assigned to go to the homes of Medicare beneficiaries to complete assessments that determined the necessary level of care required for the beneficiary and the reimbursement rate for the claims made by Abide. When EDWARDS, WASHINGTON, DEJEAN, HOPKINS, and KOON completed these assessments, they routinely and fraudulently included a group of diagnoses that were unrelated to the needs of the beneficiaries and included items suggesting the need for assistance with different activities of daily living in order to falsely inflate the reimbursement rates paid by Medicare to Abide. EDWARDS, WASHINGTON, HOPKINS, DEJEAN and KOON also fraudulently included other items in the assessment to falsely document the beneficiary’s homebound status.
After assessments were completed, Abide generated plans of care reflecting the falsely created assessments. The plans of care were given to DRS. BARNES, EVANS, MOLDEN and MICHAEL JONES to falsely certify and recertify medically unnecessary episodes of home health. Licensed practical nurses (LPNs) assigned to beneficiaries, including BATTAGLIA, performed skilled nursing visits usually once a week and BATTAGLIA routinely falsified documentation of visits to support the ongoing fraudulent billing by PAULA JONES, on behalf of Abide, of medically unnecessary home health services.
The Superseding Indictment also charges SHELTON BARNES with obstruction of a federal audit in connection with his billing to Medicare Part B of services related to the medically unnecessary home health services.
If convicted, VERINESE SUTTON and LARRY TAYLOR, face a possible maximum sentence of 5 years imprisonment; JONATHAN NORA and PAULA JONES face a possible maximum sentence of 15 years imprisonment; ERICA EDWARDS and SUPRENIA WASHINGTON face a possible maximum sentence of 20 years imprisonment; CAREN BATTAGLIA and ZELLISHA DEJEAN face a possible maximum sentence of 30 years imprisonment; DRS. HENRY EVANS and GREGORY MOLDEN face a possible maximum sentence of 35 years imprisonment; JEFFREY KOON face a possible maximum sentence of 50 years imprisonment; SHEILA HOPKINS faces a possible maximum sentence of 70 years imprisonment; DR. SHELTON BARNES faces a possible maximum sentence of 110 years imprisonment; and DR. MICHAEL JONES face a possible maximum sentence of 125 years imprisonment. For each count for which any defendant is convicted, they are subject to a $250,000 fine.
U. S. Attorney Polite reiterated that the Indictment is merely a charge and that the guilt of the defendants must be proven beyond a reasonable doubt.
U.S. Attorney Polite praised the work of the Special Agents of the Federal Bureau of Investigation in the ongoing investigation. Assistant U.S. Attorneys Patrice Harris Sullivan, Sharan Lieberman and Andre Lagarde are in charge of the prosecution.