Twenty Individuals and One Corporation Indicted for Conspiracy to Commit $30 Million in Health Care Fraud
U.S. Attorney Kenneth A. Polite announced that a 26-count indictment was returned against twenty individuals and one corporation, charging approximately $30,052,295 in Medicare fraud.
Specifically, LISA A. CRINEL, age 51; WILNEISHA HARRISON JAKES, age 28; HENRY EVANS, age 70; THREASA ADDERLEY, age 63; MICHAEL JONES, age 45; PAULA JONES, age 44; SHELTON BARNES, age 61; CARY PAYTON, age 60; EVELYN ODOMS, age 63; SHEILA MATHIEU, age 46; SUPRENIA WASHINGTON, age 58; ERICA EDWARDS, age 30; ZELLISHA DEJEAN, age 36; CAREN BATTAGLIA, age 48; SHEILA HOPKINS, age 62; VERINESE SUTTON, age 62, all of New Orleans; JONATHON NORA, age 27, of River Ridge; ELESHIA WILLIAMS, age 44, of Harvey; and PCAH, INC. a/k/a PRIORITY CARE AT HOME, INC. (PCAH) d/b/a ABIDE HOME CARE SERVICES, INC., a Louisiana corporation, were indicted today 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. CLARA AITCH, age 39, of New Orleans, and WENDY ERVIN, age 41, of Laplace, were indicted for conspiracy to commit wire fraud along with CRINEL and JAKES. CRINEL is also charged with wire fraud.
According to the indictment, the defendants participated in a criminal organization for the purpose of fraudulently billing Medicare. CRINEL was the owner and operator of a home health company known as ABIDE. Through her operation of ABIDE, CRINEL and her daughter JAKES, as Chief Administrative Officer, hired “House Doctors” to sign orders and plans of care for Medicare beneficiaries who had no legitimate medical necessity for home health services. The House Doctors, including DRS. BARNES, EVANS, ADDERLEY and MICHAEL JONES, falsely signed home health orders regardless of the beneficiary’s needs, homebound status, or diagnoses. In return, DRS. BARNES, EVANS, and ADDERLEY 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 making monthly payments to DR. MICHAEL JONES like the other House Doctors, CRINEL and ABIDE hired PAULA JONES, DR. MICHAEL JONES’s wife, and thereafter, inflated salary payments to PAULA JONES, representing MICHAEL JONES’s fees for fraudulently certifying home health for ineligible Medicare beneficiaries.
WILLIAMS and other ABIDE marketers contacted JONATHON 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, knowing that the individual referral to ABIDE was by a Marketer, instead of the beneficiary’s own health care professional.
Registered nurses, including MATHIEU, EDWARDS, WASHINGTON, DEJEAN, and HOPKINS 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 MATHIEU, EDWARDS, WASHINGTON, DEJEAN and HOPKINS, 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. MATHIEU, EDWARDS, WASHINGTON, HOPKINS and DEJEAN 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, ADDERLEY and MICHAEL JONES to falsely certify and recertify medically unnecessary episodes of home health. Licensed practical nurses (LPNs) assigned to beneficiaries, including ODOM, PAYTON and BATTAGLIA, performed skilled nursing visits usually once a week, and ODOM, PAYTON 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.
In the wire fraud conspiracy and three individual wire counts, CRINEL is charged with filing fraudulent applications for relief relating to the April 20, 2010 explosion and fire which occurred on the Deepwater Horizon, an oil rig in the Gulf of Mexico where British Petroleum (BP) had been drilling a well. After the disaster, BP established the Gulf Coast Claims Facility (GCCF) to administer, mediate, and settle claims of individuals and businesses for losses incurred as a result of the Deepwater Horizon incident. The GCCF began receiving and processing such claims in August 2010. The GCCF required any individual filing a claim to submit valid documentation as proof of loss or reduction in earnings due to the oil spill. CRINEL and a Georgia accountant created false documentation on behalf of AITCH, ERVIN, and JAKES, to include in fraudulent applications for reimbursement for lost wages. The false documentation stated that AITCH, ERVIN and JAKES, at the time of the BP disaster, were employed by LACE, a reception hall owned and operated by CRINEL, when, in truth, AITCH and ERVIN were full time employees of ABIDE and JAKES was attending school out of state. After AITCH and ERVIN received payments from BP, they had to kick back some of the funds to CRINEL. The loss to BP from the fraudulent claims totals $37,800.
If convicted, the defendants face the following possible maximum terms of imprisonment:
- VERINESE SUTTON, CLARA AITCH and WENDY ERVIN - 5 years;
- JONATHON NORA - 10 years;
- ELESHIA WILLIAMS, PAULA JONES and CARY PAYTON - 15 years;
- ERICA EDWARDS, WILNEISHA HARRISON JAKES and SUPRENIA WASHINGTON - 20 years;
- CAREN BATTAGLIA and ZELLISHA DEJEAN - 30 years;
- DRS. HENRY EVANS and MICHAEL JONES - 35 years;
- SHEILA MATHIEU - 35 years;
- EVELYN ODOMS - 50 years;
- SHEILA HOPKINS - 80 years;
- DR. SHELTON BARNES - 85 years;
- THRESA ADDERLEY – 85 years; and
- LISA A. CRINEL - 270 years.
For each count for which any defendant is convicted, they are subject to a $250,000 fine. And, if convicted, PCAH, INC. a/k/a PRIORITY CARE AT HOME, INC. (PCAH) d/b/a ABIDE HOME CARE SERVICES, INC. faces millions in fines.
The indictment also charges forfeiture of property including real estate, bank and life insurance accounts, and jewelry purchased with the proceeds of health care fraud.
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 Federal Bureau of Investigation; and the U.S. Department of Health and Human Services, Office of Inspector General in this ongoing investigation. Assistant U.S. Attorneys Patrice Harris Sullivan, Sharan Lieberman and Andre Lagarde are in charge of the prosecution.