Nine charged in scheme to defraud Medicaid
Owner and employees of Eye For Change Youth & Family Services indicted for fraudulent Medicaid billing practices.
First Assistant U.S. Attorney Bridget Brennan announced today that a federal grand jury sitting in Cleveland has returned a 28-count indictment charging nine individuals for their roles in a scheme to defraud Medicaid. These nine individuals either owned, operated or worked for Eye For Change Youth & Family Services, Inc. (Eye For Change), a non-profit corporation in Cleveland.
First Assistant U.S. Attorney Bridget Brennan, FBI Special Agent in Charge Eric B. Smith, Office of the Inspector General, U.S. Department of Health and Human Services Special Agent in Charge Lamont Pugh III and Ohio Attorney General Dave Yost made the announcement.
“These defendants are accused of defrauding a tax-payer funded health care benefit program that was created to assist some of the most vulnerable among us,” said First Assistant U.S. Attorney Bridget Brennan. “Their alleged conduct, including the payment of kickbacks, was designed simply to enrich themselves. We are grateful for the hard work of the agencies involved who, like us, are dedicated to bringing allegations of fraud and illegal kickbacks before the court.”
"These individuals engaged in a scheme to defraud tax-payers by submitting fraudulent billing to a federally funded healthcare program, which is supported by hard-working citizens,” said FBI Special Agent in Charge Eric B. Smith. “The FBI and our partners will continue to root out such fraud and hold those engaged in illegal financial dealings responsible in a court of law.”
“The billing of medical services that are not rendered, the payment of kickbacks, and the falsification of documents with respect to medical records are illegal acts commonly used by those who commit healthcare fraud,” said Lamont Pugh III, Special Agent in Charge, U.S. Department of Health & Human Services, Office of Inspector General – Chicago Region. “The OIG routinely conducts data analysis in an effort to identify aberrant and potentially fraudulent billing trends and will take action to hold those who seek to defraud federally funded health care programs accountable.”
"There are actually real people out there who are suffering and need help," Ohio Attorney General Dave Yost said. "You don't have to make up imaginary patients. A jury of their peers will undoubtedly know some of them. I'm grateful for the state-federal partnership that is bringing these fakes to justice."
Named in the indictment are:
- Alfonzo D. Bailey, age 38, of Cleveland, Ohio. Bailey was the incorporator and 100% owner of Eye For Change Youth & Family Services.
- David Brown, age 39, of Maple Heights, Ohio. Brown was a marketer and Clients Rights Officer at Eye For Change.
- Valerie White, age 51, of Columbus, Ohio. White was employed as a Qualified Mental Health Specialist (QMHS) and a counselor/therapist who provided counseling services to Eye For Change Medicaid beneficiary clients.
- Sandra Wilson, age 52, of Cleveland, Ohio. Wilson was employed as an assessor and staffed the crisis hotline at Eye For Change and provided counseling services Medicaid beneficiary clients.
- Cheria Oliver, age 31, of Canal Winchester, Ohio. Oliver was employed as a Qualified Mental Health Specialist (QMHS) at Eye For Change and provided counseling services to Medicaid beneficiary clients.
- Charchee Tucker, age 43, of Warrensville Heights, Ohio. Tucker was employed as QMHS, QMHS Supervisor, Lead Case Manager, and Director of Marketing and Compliance. Tucker was to provide counseling services to Eye for Change Medicaid beneficiary clients.
- Allen Steele, age 38, of Parma, Ohio. Steele was employed as a QMHS at Eye For Change and was able to provide counseling services to Medicaid beneficiary clients.
- Kamelah Ganaway, age 43, of Macedonia, Ohio. Ganaway was employed as a QMHS at Eye For Change and was to provide counseling services to Medicaid beneficiary clients.
- Tremayne Kellom, age 41, of Cleveland, Ohio.
According to the indictment, from February 2017 through September 2020, the defendants are accused of submitting, or allowing to be submitted, billings to the Medicaid program for services that were never performed and of falsifying records.
The indictment states that Bailey would pay White and Wilson, a Licensed Independent Social Worker (LISW) in order to use Wilson’s LISW provider number and credentials to submit billings and documents regarding mental health screenings that were never performed.
Bailey, Brown, White and Wilson would also submit billings to the Medicaid program for counseling services without an appropriate treatment plan in place for clients, as required by law.
In addition, Bailey, Brown, White and Wilson are accused of allegedly paying kickbacks in the form of cash, gift cards, and rent/bill payments to Medicaid beneficiaries in order to obtain these beneficiaries as clients and to bill Medicaid for services never rendered.
The indictment further states that Bailey, Brown, White and Wilson would direct employees to misdiagnose their Medicaid beneficiaries in order to receive authorization from the Ohio Department of Medicaid to provide services and bill at higher rates.
Bailey, Brown, Oliver, Tucker, Steele, Ganaway and Kellom are also accused of allegedly directing and allowing employees to insert false progress notes into Medicaid beneficiary electronic records in order to create the fictitious documents needed to submit their claims.
As a result of these offenses, the defendants shall forfeit approximately $2.3 million seized during the execution of a federal seizure warrant and all properties associated with Eye For Change in Cleveland, Cleveland Heights and Columbus.
An indictment is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.
If convicted, the defendant’s sentence will be determined by the Court after review of factors unique to this case, including the defendant’s prior criminal record, if any, the defendant’s role in the offense and the characteristics of the violation.
In all cases, the sentence will not exceed the statutory maximum and in most cases it will be less than the maximum.
The investigation preceding the indictment was conducted by the Cleveland Division of the FBI, the Department of Health and Human Services -- Office of the Inspector General and the Ohio Attorney General’s Healthcare Fraud Section. This case is being prosecuted by Assistant U.S. Attorney Michael L. Collyer and Special Assistant U.S. Attorney Jonathan L. Metzler.