South Carolina: $9 Million Health Care Fraud Busted Thanks to a Whistleblower

01/21/201909/21/2019 ~ Ann Corcoran ~ 1 Comment

I’m posting just a bit of this news from Columbia, SC as a follow-up to the post I wrote a few days ago about the False Claims Act and because I want to encourage readers to be proactive in looking for Medicare and Medicaid fraud where you live.

SC woman charged in alleged $9 million fraud involving autism care

Federal authorities are seeking to recover $9 million that they say a S.C. woman stole in a wide-ranging scheme involving false medical bills for treating autistic children.
Susan A. Butler, the “founder” of the S.C. Early Autism Project, is charged with overbilling Tricare and Medicaid, two federal health insurers, and making false claims about patient services. Money the insurers paid for patient care instead went for administrative costs, according to a federal grand jury indictment made public Wednesday.

You can read more about Ms. Butler, but this is the part I want you to see.

In August, the U.S. Attorney’s office in Columbia announced the Early Autism Project had paid $8.8 million to settle a civil case under the False Claims Act, alleging it had submitted false claims to Tricare and the S.C. Medicaid program for children with autism.
[….]
…in the August press release, the U.S. attorney’s office in Columbia said the case began when a whistleblower, former Early Autism Project employee Olivia Zeigler, brought the allegations to the government’s attention.
Under the False Claims Act, a whistleblower can file a lawsuit on behalf of the government. If the government gets involved and recovers money, the whistleblower gets part of any settlement. Zeigler was paid $435,000, the U.S. attorney’s office said.

More here.
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If you want to report suspected fraud in any program involving the Dept. of Health and Human Services (Medicare, Medicaid, Refugee agency contracts (!)) go here.
Or, go back to my post on the False Claims Act and see what steps you need to take as a whistleblower filing a qui-tam case.

What can you do?

If you suspect fraud, it is your duty to do something! (And, heck you might even be rewarded as Ms. Zeigler was!).
Just reading news and shaking your head about it is downright lazy! Do something, even if it is only to share the news within a circle of friends and family!

Nevada: Illegal Alien is Prime Suspect in Recent Murder Spree

01/21/201909/21/2019 ~ Ann Corcoran ~ 20 Comments

Wilbur Ernesto Martinez-Guzman, 19, has been arrested and is expected to be charged in several murders of senior citizens in recent weeks in the Carson City, NV area.
From KOLO 8 (an ABC affiliate) (hat tip: TwoLaine):
The elderly are resting easier in Nevada, but should they?

Murder charges expected against suspect in killings

RENO, Nev. (KOLO) – A man apparently in the United States illegally is the primary suspect in four Northern Nevada murders, and no one else is being sought.
January 20, 2019, Washoe County Sheriff Darin Balaam hosted a multi-agency news conference to announce the arrest of 19-year-old Wilbur Ernesto Martinez-Guzman. Carson City Sheriff Ken Furlong says the suspect had lived in the Carson City area about a year, but has no local record.

Prime suspect in killing spree of senior citizens Wilbur Ernesto Martinez-Guzman

The suspect is so far charged with burglary, possession of stolen property and obtaining money by false pretenses, and he is on an immigration hold. District Attorneys from Washoe County and Douglas County hope to file murder charges against him in the coming days, saying there is enough evidence to support such charges.
The suspect was taken into custody Saturday, January 19, 2019 in Carson City. Carson City Sheriff Ken Furlong says he was arrested on an immigration charge after being rammed by deputies on Carson Street in the Carson Mall parking lot. The suspect had already been identified as a person of interest through the investigation and tips from the public, and had been under surveillance. That operation involved several Carson City neighborhoods.

Were they murdered in their beds?

No information about a possible motive for the killings has been offered.
The first killing took place January 9 or 10, 2019. 56-year-old Connie Koontz was found shot to death at her home in the Gardnerville Ranchos.
[….]
January 13, 74-year-old Sophia Renken was found dead in her home about a mile away, also shot to death.
January 16, the bodies of 81-year-old Gerald David, a former Reno Rodeo President, and his wife, 80-year-old Sharon David, were found dead in their home on La Guardia Lane in south Reno, near Zolezzi. They also had been shot to death.

More here. Be sure to watch the news clip!
The reporter says they don’t want to put out a lot of publicity that might taint the jury pool. What the heck! This should be a national news story. As of this writing I only see it mentioned in Nevada media.
By the way, no mention of his nationality yet. (If anyone sees that let me know!).

I guess we are going to have angel children joining angel moms!

This is what you need to do. Get this story out as widely as possible. The President needs to know about it!

Worcester "Man" Admits Guilt in Identity Theft Scheme at Crooked Convenience Store

01/20/201909/21/2019 ~ Ann Corcoran ~ 2 Comments

visa fraud
I sometimes think the media, which you might assume would want titillating headlines, downplays stories like this so people won’t bother reading it!
Of course the headline isn’t going to say “illegal from Ghana” admits guilt!
Here is the Worcester Telegram headline and story,

Worcester store employee admits to identity theft

WORCESTER – A Worcester man who worked at a city store whose owner was jailed for $3.6 million in food stamp fraud admitted Tuesday to stealing people’s identities.
Yaw Okyere, 36, a citizen of Ghana who overstayed a student visa in 2009, pleaded guilty to one count of aggravated identity theft and one count of possessing five or more identification documents.
Mr. Okyere was arrested last year after authorities said they found evidence of identity theft and dozens of boxes of pricey merchandise in his apartment.
He had nearly 200 state driver’s licenses in files on his computer, authorities said, and apparently used other people’s identities to order goods through the mail.

Why is this store still open? Owner found guilty in 2016 of $3.6 million in food stamp fraud, the largest bust in Massachusetts’ history. She was sentenced to one year in the slammer. https://www.telegram.com/news/20160711/worcester-woman-behind-36m-food-stamp-fraud-gets-year-in-jail

Authorities allege in court documents that Mr. Okyere had intermediaries bring the ill-gotten goods to his day job at J&W Aseda Plaza, the same Worcester store where $3.6 million in food stamp fraud was perpetrated several years ago.
Mr. Okyere is described in court documents as a relative of the store owner, Vida Causey, who was sentenced to a year in jail. He told authorities who raided his home she was his aunt.
The charges Mr. Okyere faces carry combined maximum penalties of up to 17 years in prison and a fine of up to $500,000. He also faces possible deportation.

What! Possible deportation! Possible deportation! Deport him now and save the taxpayers the cost of keeping him in prison!
More here.
I couldn’t find a photo of the Ghana illegal alien man, but wondered if that might be him standing outside of his aunt’s business!
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What can you do?

This is one more story that should be reported in the mainstream media so Americans would have a better idea of the kinds of frauds to watch for and the kinds of fraudsters that are out there. Best thing you can do is to send this story out to your social media networks. Be sure to mention the student visa fraud!

Cleveland: Suit against Catholic Charities in boy's shocking death

01/20/201909/21/2019 ~ Ann Corcoran ~ 16 Comments

A social worker, employed through a contract with Catholic Charities of the Catholic Diocese of Cleveland was supposed to be checking on and protecting the nine children in the Rodriguez home, but instead she had cooked up a deal with the children’s mother to obtain the family’s food stamps.
catholic charities diocese of cleveland
In exchange she allegedly turned a blind eye to abuse and deplorable living conditions that resulted in the death of a five-year-old boy whose body was buried in the back yard.
The case became known to the police when someone called from PAKISTAN with a tip! WTH!
This is the latest news from Cleveland.com:

Estate of Cleveland boy found buried in back yard sues Catholic Charities

CLEVELAND, Ohio — The estate of a 5-year-old Cleveland boy whose body was found in late 2017 buried behind his mother’s house has filed a lawsuit against the social services arm of the Catholic Diocese of Cleveland that employed the worker who was supposed to keep tabs on the family.
The survivorship of Jordan Rodriguez filed the wrongful death lawsuit Tuesday in Cuyahoga County Common Pleas Court against Catholic Charities, its employee Nancy Caraballo, the boy’s mother Larissa Rodriguez and her boyfriend Christopher Rodriguez.

Nancy Caraballo

The suit accuses Catholic Charities and Caraballo of recklessness, negligence and failing to report abuse the boy suffered in the two years leading up to his death. The estate, administrated by Michelle Rodriguez, seeks to take the case before a jury.
“While we cannot at this time comment on what is alleged in the lawsuit, Catholic Charities protects and advocates for those who are most vulnerable,” the statement said. “All employees undergo thorough background checks and extensive training with regard to ethics and specifically their duties to report child abuse or neglect.”
Jordan’s body was discovered buried in the family’s backyard in December 2017, after Cleveland police received a call from Pakistan that said Christopher Rodriguez confessed to burying the child.
Investigators responding to the call found the home in deplorable condition, and it wasn’t long before they uncovered that Caraballo, a parent educator at an agency contracted with Catholic Charities who was assigned to the Rodriguez family, had been buying Larissa Rodriguez’s food stamps at discounted prices and lying in her reports of her visits.
Caraballo was supposed to conduct monthly home visits to check on Rodriguez’s children and living conditions and file a report each time. But investigators subpoenaed her cellphone records and compared text messages between Caraballo and Rodriguez to the reports and found that, on at least 12 occasions, Caraballo simply showed up to Rodriguez’s house to pick up the food stamp card. She filed false reports that said she inspected the home.

More here.
The case will make you sick!
In February Caraballo plead not guilty here.
Then here in April she was sentenced to 3 years for the food stamp fraud.
And, now get this, she reformed in jail and was out in six months, here.

As is usual there is no mention of the immigration status of either Caraballo or the Rodriquez duo.

But I am interested in why a call to police came from Pakistan. Were there Pakistani convenience store proprietors in on the food stamp fraud?

Feds Recover $2.5 Billion from Health Care Industry Fraud in 2018

01/19/201909/21/2019 ~ Ann Corcoran ~ 4 Comments

That is just the money recovered in successful health care fraud cases. Imagine how much more goes undetected!

Here is the news of the Department of Justice’s annual report for 2018 for legal judgements under the federal False Claims Act. (Fascinating! the Act has been around since the Civil War.)
I know this might sound pretty boring, but you need to know about it especially as some of the successes come from “whistleblowers” who are able to make some serious money while unearthing fraud in primarily (in this case) the health care sector.
So, if you work for a doctor or hospital and notice some strange financial transactions, or see something suspicious on your Medicare statements, keep this in mind!
From a report by the law firm Holland & Knight:

In December 2018, the U.S. Department of Justice (DOJ) released its annual statistics for its civil False Claims Act (FCA) and fraud cases from the fiscal year ending Sept. 30, 2018 (fiscal year 2018). The DOJ reports it recovered $2.8 billion in settlements and judgments for Fiscal Year 2018. Of the $2.8 billion recovered in fiscal year 2018, $2.5 billion involved the healthcare industry—the ninth consecutive year that the DOJ’s civil health care fraud settlements and judgments have exceeded $2 billion.
[….]

….the FCA is used by the U.S. government to combat healthcare fraud and also serves as the primary civil remedy for redressing false claims involving federal government contracts, grants, and federally-funded programs.
FCA cases can originate in one of two ways: (1) actions brought by the DOJ, or (2) actions brought by whistleblowers, known as relators, who are entitled to a portion of any proceeds recovered through settlement or judgment. In the latter actions, called qui tam actions, the case is filed under seal and the DOJ is given a period of time to evaluate the allegations and decide whether to intervene (i.e. take over the case). If DOJ declines to intervene, the relator may proceed with the action and potentially receive a greater cut of the recovery.
[….]
…in the healthcare industry newly brought qui tam cases are down while non-qui tam cases are slightly up.
[….]
The increase in government-initiated healthcare cases may be attributable to enforcement initiatives such as the nationwide Medicare Strike Force Teams. These teams, which are scattered throughout the United States, focus on criminal and civil health care fraud.

Feds are increasing the number of US Attorneys in key hot spots!

The trend line for government-initiated FCA actions should increase over the next few years. DOJ recently added a cadre of new affirmative civil enforcement attorneys, whose role will include initiating cases under the FCA. The new Assistant United States Attorneys (AUSAs) are being placed throughout the country—and offices where there is a hotbed of government contracting and healthcare are receiving more than one new AUSA. While most U.S. Attorney’s Offices will receive one additional AUSA for affirmative civil enforcement, DOJ announced that offices such as Colorado, Middle District of Florida, Southern District of Florida, Massachusetts, New Jersey, Eastern District of New York, Southern District of New York, and Eastern District of Virginia, would receive two.

More here.

This got me thinking. Have you seen any funny money business going on with the US Refugee Admissions Program and the Dept. of Health and Human Services contractors?

If so, think about this avenue to bring attention to possible fraud! You might actually make a few bucks in the process!

Afterthought: I need to be sure to let new readers know why I write this blog, here is my “welcome” post from January first.