Articles Posted in Fraud

New York Attorney General Eric Schneiderman announced that Channel Francis had been indicted for five felonies relating to allegations that she assumed the identities of three nursing home patients and illegally used their credit cards.

Schneiderman charges that Francis obtained the information from residents of the Parker Jewish Institute for Health Care and Rehabilitation in Queens, New York around September 2013. According to Schneiderman, Francis then added herself as an authorized user on credit cards that were owned by the residents and proceeded to purchase iPads, computers, televisions, and designer purses on the three victims’ credit cards – spending between $3,000 and $4,700 on each of the resident’s credit cards. After being tipped off by the victim’ relatives of the unauthorized charges, the New York City Police Department opened an investigation into the matter.

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On October 18, 2016, six individuals were arrested in New York for  exploiting the financial vulnerability of nursing home residents; defendants are from Bronx, New York, Queens and Suffolk Counties. The five New York City defendants stole personal identity information from residents in order to secure cash or credit they were not entitled to; and the defendant from Suffolk County stole a necklace from a 95 year old female resident. Attorney General Eric T. Schneiderman stated it is “reprehensible for caregivers to steal from defenseless residents in order to line their own pockets.” He continued to say his office will not tolerate financial exploitation and will vigilantly work to ensure nursing home resident’s personal and financial information is protected.  The six cases are summarized below:

  1. Diana English, Director of Social Services at Far Rockaway Nursing Home in Queens – Allegedly removed an elderly resident from the home and took him to his bank to withdraw money without the required medical clearance on June 24, 2015. The resident withdrew $500 from his account and gave it to the director; this occurred several times. The resident passed away the following month; English accessed his account with his PIN number and stole $1,200 from his account. The resident suffered from an anxiety disorder, physical issues due to hip replacement surgery, short and long term memory deficits , cognitive deficits and was unable to care for himself. She was arraigned in New York City Criminal Court – Queens County and is being charged with Endangering the Welfare of an Incompetent or Physically Disabled Person in the First Degree, Grand Larceny in the Fourth Degree, and Falsifying Business Records in the First Degree.
  2. Sandra Rivera-Tapia, Director of Social Work at Holliswood Center for Rehabilitation and Healthcare in Queens – Allegedly obtained a resident’s ATM card and PIN number and stole $7,418 from the account. The money was acquired by making several cash withdrawals from various ATM’s in her neighborhood and throughout New York City, as well as store purchases on the card. The resident suffered from schizoaffective disorder, obsessive compulsive disorder, sublaxation of the right hip, chronic kidney disease, diabetes and hypertension and was unable to care for himself. She was arraigned in New York City Criminal Court – Queens county and charged with two counts of Grand Larceny in the Third Degree, Endangering the Welfare of an Incompetent or Physically Disabled Person in the First Degree, and Unlawful Possession of Personal Identification Information in the Third Degree.

The Department of Justice (DOJ) announced the creation of regional task forces whose objective will be to toughen enforcement against nursing homes providing substandard care. This initiative was launched in accordance with the DOJ’s Elder Justice Initiative and is expected to include members from the U.S. Attorney’s Office, Medicaid Fraud Control Units, state and local prosecutor’s offices, Department of Health and Human Services, state Adult Protective Services, Long-Term Care Ombudsman, and law enforcement. These groups will come together to exchange information and share their concerns on substandard nursing homes with hopes of resolving these issues in a timely and effective manner.

Benjamin Mizer, Principle Deputy Assistant Attorney General, used the 2014 Extendicare Health Care Services case as an example of a similar collaboration that was successful. Extendicare and its subsidiary were billing Medicare and Medicaid for substandard nursing care, unnecessary rehabilitation therapies, not following protocol to prevent pressure ulcers and falls, and not having enough nurses to care for patients; the company was able to work with the federal government and eight states and settle the case for $38 million. The DOJ worked closely with other agencies and state governments in this case to come to an agreement and Mizer hopes to expand this model of federal-state collaboration through the task forces. Continue reading

On January 4, 2016 Attorney General Eric T. Schneiderman announced several guilty pleas in connection with  allegations against Mohawk Valley Health Care Center (MVNH) for falsifying business records and covering up nursing home resident abuse and neglect. In a separate civil settlement, MVNH Associates, LLC also agreed to pay a $1,000,000 fine to Medicaid for accepting overpayments from the program. The company will also be required to hire an independent monitor to implement reform and divest ownership of the two convicted defendants and a related investor.

The indictment included details of two incidents that occurred in May 2013 and the alleged cover up of those incidents. The first incident included a medication error that went unnoticed for several days and was then covered up.  The second incident involved a resident with dementia who took part in unlawful sexual conduct with another resident. MVNH’s guilty plea resolved these issues, which initially were part of a 45 count indictment. The plea involved admitting to adding an employee’s name to a staffing sheet who was not working. MVNH also had to pay a $5,000 fine. Two owners of the facility, a former administrator and director of nursing, pled guilty to separate charges. Continue reading

Linda Masse, a Licensed Practical Nurse, pled guilty in Schenectady County Court to one count of Criminal Possession of a Forged Instrument in the Second Degree, a Class D Felony, with a sentence of felony drug court.  Masse also agreed to surrender her nurse practitioners license.

Linda Masse was a licensed practical nurse at Women’s Health Care Associates in Latham, New York for a physician who specialized in obstetrics and gynecology.  It was revealed that from March 2014 to approximately April 2015, Linda Masse used eighteen forged prescriptions from her employer’s medical practice in order to obtain hydrocodone and oxycodone from various pharmacies, including Walmart and CVS. For each prescription, Masse would obtain large amounts of narcotics- varying from 40 to 180 pills.pills8 Hydrocodone and oxycodone are Schedule II controlled substances meaning that the drugs have a high potential for abuse, therefore restricting the use of those drugs. Masse obtained over 2,000 pills of hydrocodone and oxycodone, which were paid for by Medicaid. Masse committed Medicaid fraud by unlawfully issuing prescriptions in her name and forging a physician’s signature. Continue reading

Claire Weiland, a receptionist at Livingston Hills Nursing Home in Columbia County, was arrested for stealing over $6,000 from the resident trust account at the nursing home where she worked. Attorney General Eric Schneiderman stated that the exploitation of nursing home residents for personal gains will not be tolerated. Residents entrust their funds to the care of the staff of the home for safekeeping and are being abused in return.
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The New York State Office of the Attorney General is responsible for investigating and prosecuting a vast quantity of crimes in the state of New York. While many of the more widely publicized investigations involve drug distribution and conspiracies, Medicaid fraud has become a growing trend in the state of New York, and Attorney General Schneiderman has been doubling down on Medicaid fraud in the recent years.

The Office of the Attorney General now has a Medicaid Fraud Control Unit dedicated to detecting Medicaid fraud at doctor’s offices, nursing homes, hospitals, non-profits, and more. State and federal taxpayer dollars fund New York’s Medicaid program, thus fraudulent use of Medicaid funds wastes taxpayer money. In addition, it diverts much-needed funding from worthy programs and patients.

RAIN, or Regional Aid for Interim Needs, is a non-profit designed to provide services to the vulnerable elderly population. These services include home attendants, senior centers, Meals-on-Wheels, social services, and senior housing complexes. These services are funded in part by state Medicaid dollars. Beginning in 2003, RAIN’s former Executive Director, Louis Vasquez, dipped into the Medicaid pot and diverted Medicaid funds from financing healthcare services for elderly residents in the Bronx to paying over $800,000 in mortgage payments for an empty building.

The nonprofit Mental Health Association of Rockland County, Inc. has agreed to settle with the New York State Office of the Attorney General for $304,000 in response to allegations that the nonprofit altered Medicaid records. In its settlement agreement, the nonprofit admitted to the allegations and accepted responsibility for its actions.

Medicaid is a state and federal taxpayer-sponsored program in the state of New York. Nonprofits that provide healthcare services to vulnerable and indigent populations such as those with mental health issues are eligible for funding from Medicaid. Medicaid funds can only be used to cover services and equipment associated with its mission. Ancillary costs and fees, such as rent or payroll, cannot be covered with Medicaid funds. Generally the facility will bill Medicaid directly for visits, treatment, procedures, services, and more. Medicaid then reimburses the facility.

Mental Health Association of Rockland County overcharged Medicaid for patient visits by inflating the number of hours that patients spent at the health center. In order to bill Medicaid for patient visits, the health center documented the number of hours spent in the Continuing Day Treatment Program, a mental health treatment program for adults, each day.

According to the National Council on Aging, phone scams targeting elderly victims have become so prevalent that they are now considered the “crime of the 21st Century.” The scams are often difficult to trace and are considered a “low risk” crime by fraudsters. Beth Finkel, Director of the AARP in New York, remarked, “It’s estimated that fraud cost older Americans $2.9 billion in 2011 alone, and as society ages and people live longer this problem threatens to get worse.”

To combat these phone scams, which usually spike during the summer months, Attorney General Eric Schneiderman warned potential elderly victims to beware of five common fraudulent phone calls. The first such scam involves a person who calls an elderly person and claims to be the victim’s grandson or granddaughter. In some cases, the scammer will have obtained the grandchild’s name from social media sites. In other cases, the scammer will trick the elderly person into giving the grandchild’s name by saving, “Hey! It’s me. You know who this is?” Once the elderly victim believes that the caller is his or her grandchild, the scammer will then state that he or she is in trouble and needs money immediately. The caller may say that he or she is going to be evicted or needs money to be bailed out of jail.

phone.jpgAnother scam involves a caller who claims to be an officer of the court. The caller will tell the elderly person that there is a warrant out for their arrest for failing to report to jury duty. To avoid arrest, the scammer will tell the elderly victim to send money via services such as Western Union. In one case, investigators were able to trace such a call to a Georgia prison.

The results of a 2011 report, a collaboration of numerous agencies, show that financial exploitation of the elderly resulted in $2.9 billion in losses to victims in 2010. Moreover, the study, titled, “The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation against America’s Elders,” further concluded that losses from financial abuse were up by 12 percent since 2008, which saw a $2.6 billion loss to victims. Among the findings, the study reported that 51 percent of elder financial abuse involved strangers; 34 percent of financial abuse involved family, friends and neighbors; 12 percent of the cases involved businesses, including nursing homes, and four percent involved cases of Medicare and Medicaid fraud.

While Medicaid and Medicare fraud cases only represented four percent of elder financial abuse, such cases had the greatest financial impact on the victims. The report concluded that these fraud cases resulted in $38,263,136 in losses to victims in 2010. Financial exploitation of the elderly that involved legitimate businesses, such as financial consulting firms and nursing homes, resulted in $6,219,496 in losses. Financial exploitation involving family, neighbors and friends resulted in losses amounting to $145,768. Finally, financial elder abuse involving strangers, such as home repair and telephone scams, resulted in losses totally $95,156.

money stack.jpgThe report, which labelled financial elder abuse the “Crime of the 21st Century,” categorized the crime according to three types: occasion, desperation and predation. Occasion crimes are moments of opportunity that allows a perpetrator to take advantage of a victim. An example of such a crime would be a caretaker who finds an elderly person’s wallet on the counter and take money. Desperation crimes, however, often involve family members or friends who are desperate for money and are willing to do anything to get it. Desperation crimes often involve family members with substance abuse problems who are reliant upon the elderly victim for housing and money. Finally, crimes of predation often involved a perpetrator who gained the trust of the elder over time, only to victimize the elder by taking his or her assets and money.

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