Mother, Nurses Plead Guilty to Defrauding TennCare of $400,000
Jackson, TN – A mother and four nurses assigned to care for her now-deceased son have all pled guilty to conspiring to commit health care fraud.
According to the charging documents and plea agreements in the case, Josephine Coach’s son had a tracheotomy and required a ventilator for breathing assistance. The child, who was wheel-chair bound, also had gastrointestinal problems that required frequent monitoring. The child’s doctor ordered 19 hours of daily nursing care for the child. The child received health care through TennCare, the state of Tennessee’s Medicaid program, which provides health care services to qualifying indigent individuals.
Nurses employed with On Call Staffing, Inc. were supposed to provide the 19 hours of daily home health services ordered by the doctor. On Call Staffing was a subcontractor to Functional Independence Home Care, Inc., which contracted with TennCare to provide nursing services to patients who utilized the Medicaid program.
From January 2009 to August 2011, Coach knowingly and intentionally conspired with four of the nurses to defraud TennCare by billing the program for nursing services that were never provided to the child. Specifically, Coach and the nurses reached agreements whereby the nurses would not show up for their appointed shifts but still turn in time sheets as if they had worked. The nurses then split their pay for the shifts with Coach. As a result of the fraud, TennCare paid over $400,000 for nursing services that were never provided to the child.
"The defendants’ scheme of foregoing the medical needs of a severely disabled minor in exchange for financial gain at taxpayer expense is shocking and reprehensible," said U.S. Attorney Edward L. Stanton III. "Each defendant, including the minor’s mother, will now be held accountable at sentencing."
The nurses involved with the scheme who pled guilty include: Falesha Wilson, Carla Surratt, Nakesha Stephens, and Nicole Douglass. Evidence obtained during the investigation indicates that the nurses who made similar arrangements with Coach may have actually worked approximately two out of every seven of their reported shifts.
According to the charging documents and plea agreements:
• Between February and August 2011, each of the four nurses received at least one paycheck in the amount of $1,462.34 for services supposed to have been provided to Coach’s son. The nurses then split the paychecks with Coach.
• Each nurse was assigned to work 9.5-hour shifts with Coach’s son.
• Douglass’ tenure caring for Coach’s son lasted from January 2009 to May 2011. TennCare paid $394 per shift for Douglass. She turned in time sheets for 721 shifts during her assignment.
• Wilson’s tenure caring for Coach’s son lasted from January to June 2011. TennCare paid $394 per shift for Wilson. She turned in time sheets for 643 shifts during her assignment.
• Surratt’s tenure caring for Coach’s son lasted from May to August 2011. TennCare paid $394 per shift for Surratt. She turned in time sheets for 103 shifts during her assignment.
• Stephens’ tenure caring for Coach’s son lasted from June to August 2011. TennCare paid $394 per shift for Stephens. She turned in time sheets for 75 shifts during her assignment.
Coach’s son passed away in April 2015 at age 12.
Douglass, Stephens, and Surratt are slated for sentencing on October 2, 2015.
Wilson is slated for sentencing on October 9, 2015.
Coach is slated for sentencing on October 23, 2015.
All defendants will be sentenced by Chief Judge J. Daniel Breen. They each face up to five years imprisonment and up to a $250,000 fine.
The case is being investigated by the Tennessee Bureau of Investigation.
Assistant U.S. Attorney John Fabian is representing the government in this case.