TWO PSYCHOLOGIST INDICTED FOR ALLEGED ROLES IN $25 MILLION MEDICARE FRAUD

FROM:  U.S. JUSTICE DEPARTMENT 

Thursday, October 22, 2015

Two Psychologists Charged in $25.2 Million Fraud Scheme Involving Psychological Testing in Gulf Coast States

Two clinical psychologists were charged with participating in a $25 million Medicare fraud scheme involving psychological testing in nursing homes in Gulf Coast states.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Kenneth A. Polite of the Eastern District of Louisiana, Special Agent in Charge Michael J. Anderson of the FBI’s New Orleans Field Office and Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Regional Office made the announcement.

Beverly Stubblefield, Ph.D., 62, of Slidell, Louisiana, and John Teal, Ph.D., 46, of Jackson, Mississippi, were charged by a superseding indictment with conspiracy to commit health care fraud and conspiracy to make false statements related to health care matters.  Two other defendants, Rodney Hesson, Psy.D., 46, and Gertrude Parker, 62, both of Slidell, were charged in the initial indictment returned in June 2015 in connection with a large-scale Medicare Fraud takedown, and were also charged in today’s superseding indictment.

According to the superseding indictment, Hesson and Parker owned and controlled Nursing Home Psychological Service (NHPS) and Psychological Care Services (PCS), each of which operated in Louisiana, Mississippi, Florida and Alabama.  The superseding indictment alleges that NHPS and PCS contracted with nursing homes in these states to allow NHPS and PCS clinical psychologists, including Stubblefield, Teal and Hesson, to administer to nursing home residents psychological tests and related services that were not necessary and, in some instances, never provided.

According to the superseding indictment, between 2009 and 2015, NHPS and PCS submitted more than $25.2 million in claims to Medicare.  Medicare paid approximately $17 million on those claims.

The charges and allegations contained in an indictment are merely accusations.  The defendants are presumed innocent unless and until proven guilty.

The case is being investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Eastern District of Louisiana.  The case is being prosecuted by Trial Attorneys William Kanellis and Antonio Pozos of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Patrice Harris Sullivan of the Eastern District of Louisiana.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged over 2,300 defendants who collectively have billed the Medicare program for over $7 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES WORKER SENTENCED FOR THEFT

FROM: U.S. DEPARTMENT OF JUSTICE

Tuesday, October 23, 2012
Department of Health and Human Services Employee Sentenced in North Carolina to Prison for Theft of Government Funds
WASHINGTON – An employee of the Department of Health and Human Services (HHS) was sentenced today in Asheville, N.C., to six months in prison for stealing $114,494 in government funds, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division and Special Agent in Charge Elton Malone of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), Office of Investigations, Special Investigations Branch.

Jihan S. Cover, 34, of Arden, N.C., was sentenced today by U.S. District Judge Martin Reidinger in the Western District of North Carolina. In addition to her prison term, Cover was ordered to forfeit $114,494, pay $114,494 in restitution to HHS and serve three years of supervised release, including six months of home confinement, following her prison term.

Cover pleaded guilty to one count of theft on Aug. 22, 2011.

According to court documents, Cover worked as a purchasing agent with the National Institutes of Health (NIH), National Cancer Institute (NCI), a subdivision of HHS, from approximately 2006 through December 2011. Cover’s sole job function involved procuring authorized items and services for NIH/NCI using assigned government credit cards.

According to plea documents, between June 2009 and December 2010, Cover, who received regular training in the proper use of government credit cards, used and caused to be used NIH/NCI credit cards assigned to her to complete over 250 unauthorized personal transactions totaling approximately $114,494.

During this period of time, according to her plea, Cover used and caused to be used her NIH/NCI purchase cards to make over 170 personal purchases totaling approximately $16,000 from Amazon.com for items that included toys, exercise equipment, books, clothes and other personal times. Almost all of these items were shipped to Cover’s residence in Arden. In addition, Cover admitted using her NIH/NCI purchase cards to pay off over $29,000 in balances she accrued with various cash advance and payday loan vendors.

According to plea documents, Cover also used and caused to be used her NIH/NCI purchase cards to make more than $47,000 in payments to personal accounts she caused to be created on PayPal, an online payment website. Cover directed over $46,000 from these PayPal accounts to be deposited into bank accounts that she controlled. Plea documents also revealed that in an effort to conceal her misuse of assigned purchase cards, Cover created additional PayPal accounts associated with email accounts that she controlled and which she selected to resemble the name of a legitimate NIH/NCI vendor. In this manner, Cover made over $11,000 in additional hidden payments to these PayPal accounts.

According to court documents, Cover also engaged in additional fraudulent personal transactions totaling approximately $11,000.

In addition, Cover admitted that she further sought to conceal her actions by submitting various dispute forms to the bank servicing her purchase cards, claiming that she did not recognize certain charges or did not authorize them, when, in fact, she knowingly made or caused to be made the personal charges. During her plea hearing, Cover admitted that in or about January and June 2011, she lied to investigators, claiming that she had satisfied personal transactions made with her NIH/NCI purchase cards using her personal bank account, which in fact she knew she had not. Previously, when confronted by her supervisor at NIH/NCI regarding suspicious transactions, Cover claimed falsely that she had been the victim of identity theft, when in fact she knew that she had caused the transactions.

This case is being prosecuted by Trial Attorney Eric G. Olshan of the Criminal Division’s Public Integrity Section. This case was investigated by the HHS Office of Inspector General.

LA MEDICAL EQUIPMENT SUPLIER SENTENCED FOR MEDICARE FRAUD

FROM: U.S. DEPARTMENT OF JUSTICE
WASHINGTON – A Los Angeles medical equipment supplier, who submitted almost $1 million in false claims to Medicare for expensive, high-end power wheelchairs, was sentenced today to serve 30 months in prison, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney André Birotte Jr. of the Central District of California; Glenn R. Ferry, Special Agent-in-Charge for the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); and Timothy Delaney, Acting Assistant Director in Charge of the FBI’s Los Angeles Field Office.

Adejare Ademefun, 57, was sentenced by U.S. District Judge John F. Walter in the Central District of California. In addition to the prison term, Ademefun was sentenced to three years of supervised release and ordered to pay $499,548 in restitution to Medicare.

In February 2010, Ademefun pleaded guilty to health care fraud. As part of his plea, Ademefun admitted that from January 2006 to his arrest in October 2009, he owned and operated Jamef Medical Supply, a fraudulent durable medical equipment (DME) supply company, which he used to submit almost $1 million in false claims to Medicare. Ademefun admitted he paid illicit kickbacks to co-conspirators for medical prescriptions and other documents he needed to defraud Medicare. Ademefun focused his fraudulent billings on power wheelchairs, which were among the most expensive DME that a Medicare provider could bill to Medicare. In fact, Ademefun admitted that approximately 95 percent of all the claims he submitted to Medicare were for power wheelchairs. Ademefun admitted he supplied these power wheelchairs to Medicare beneficiaries who were illegally solicited by patient recruiters or "marketers" for medical equipment they did not want or need.

Ademefun admitted he was deliberately indifferent to the fact that the power wheelchair claims he submitted to Medicare were false even though Ademefun knew there was a high probability that the doctors whose names appeared on the prescriptions he purchased from his co-conspirators did not prescribe the power wheelchairs. Ademefun also knew that only six doctors were supposedly responsible for referring approximately 50 percent of his business, and that approximately 60 percent of his customers lived more than 100 miles from Jamef. Ademefun admitted he submitted approximately $941,028 in false claims to Medicare during the course of the scheme.

On March 24, 2010, Ademefun’s co-conspirator Leonard Nwafor was sentenced to 108 months in prison for his role in the scheme.

The case is being prosecuted by Trial Attorney Jonathan T. Baum of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Kerry O’Neill of the Central District of California. The case is being investigated by the California Department of Justice and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California.

Since its inception in March 2007, strike force operations in nine locations have charged more than 1,480 defendants who collectively have billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.