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Brown Files Criminal Charges Against 25 Individuals who Defrauded Medi-Cal

Thursday, May 21, 2009
Contact: (415) 703-5837

Los Angeles – As part of a wide-ranging effort to rein-in Medi-Cal fraud, Attorney General Edmund G. Brown Jr. will today file criminal charges against two dozen in-home healthcare workers who “shamelessly bilked” the program by seeking payment for services to clients who were in fact dead, hospitalized or incarcerated.

“These individuals shamelessly bilked the Medi-Cal program by claiming payment for services never rendered,” Brown said. “In fact, their supposed clients were dead, hospitalized or incarcerated.”

Under Medi-Cal’s In-Home Supportive Services program, workers perform non-medical services for qualified Medi-Cal recipients. This includes housekeeping, grocery shopping and meal preparation. In-home healthcare workers are required to submit timesheets signed and certified by their clients to receive payment. In 2008, more than 400,000 Californians received in-home healthcare services, twice as many as in 1999. State costs for operating the program are approximately $2 billion per year.

After a 2008 audit revealed that hundreds of payment requests had been submitted for in-home services never performed, Brown’s office and the California Department of Health Care Services launched an investigation into the program, leading to the charges filed today and an ongoing investigation into physicians who facilitate this type of fraud.

Today’s charges are part of Brown’s larger effort to investigate and prosecute those who would defraud Medi-Cal, which receives approximately $20 billion in state funding every year. Over the past two years, Brown has filed legal action against 31 pharmaceutical companies, 7 medical laboratories and dozens of healthcare providers and workers, resulting in criminal charges against 204 individuals and the recovery of $225 million to the state.

Today’s Charges
The following defendants, 13 of whom have prior criminal records, will be charged with one count of grand theft and one count of presenting false Medi-Cal claims in Los Angeles County Superior Court today.

• • Larry Denman, 54, of Compton, who submitted false claims totaling $3,394 for services to his mother who, in fact, was hospitalized and later died.
• Louwanda Hurt, 40, of Los Angeles, who submitted false claims totaling $1,488 for services to her client who, in fact, had died.
• Shirley Byrd, 48, of Long Beach, who submitted false claims totaling $2,953 for services to her mother who, in fact, had died.
• Rufus Jackson, 34, of Los Angeles, who submitted false claims totaling $6,506 for services to his client who, in fact, had died.
• Christopher Thomas, 25, of Long Beach, who submitted false claims totaling $1,467 for services to her client who, in fact, had died.
• Gwendolyn Jackson, 51, of Los Angeles, who submitted false claims totaling $1,557 for services to her mother who, in fact, had died.
• Diane Trujillo, 45, of Los Angeles, who submitted false claims totaling $1,645 for services to her mother who, in fact, had died.
• Pamela Renee Nelson, 48, of Los Angeles, who submitted false claims totaling $1,935 for services to her mother who, in fact, had died.
• Nadia Hoppes, 47, of Long Beach, who submitted false claims totaling $1,634 for services to her client who, in fact, had died.
• Patches Lee Miller, 38, of Long Beach, who submitted false claims totaling $3,510 for services to her client who, in fact, had died.
• Adrianna Prude, 42, of Hawthorne, who submitted false claims totaling $4,000 for services to her client who, in fact, had died.
• Percy Sok, 25, of Long Beach, who submitted false claims totaling $1,921 for services provided to his father who, in fact, had died.
• Chris Dion Jones Sr., 42, of Lakewood, who submitted false claims totaling $4,670 for services provided to his mother who, in fact, had died.
• Brenda Denise Rochelle, 42, of Los Angeles, who submitted false claims totaling $3,386 for services to her son who, in fact, had died.
• Raymond Lee Allen, 50, of Los Angeles, who submitted false claims totaling $2,261 for services to his client who, in fact, had died.
• Melchizedek Colemen, 27, of Los Angeles, who submitted false claims totaling $4,360 for services to his client who, in fact, had died.
• Ana Bertha Pineda, 31, of Bellflower, who submitted false claims totaling $2,065 for services to her grandmother who, in fact, had died.
• Qwa'stosha Spruille, 40, of Torrance, who submitted false claims totaling $1,109 for services to her client who, in fact, had been incarcerated.
• Donna Kaye Tibbs, 52, of Los Angeles, who submitted false claims totaling $5,404 for services to her client who had been placed in a nursing home and later died.
• Roderick Edward Woods, 48, of San Pedro, who submitted false claims totaling $2,007 for services to his client who, in fact, had died.
• Gerald Robert Harris, 51, of Los Angeles, who submitted false claims totaling $6,083 for services to his mother who, in fact, had died.
• Lorraine Lee, 43, of Long Beach, who submitted false claims totaling $6,958 for care provided to her mother who, in fact, had died.
• Ernest James Rogers, Jr., 53, of Los Angeles, who submitted false claims totaling $5,010 for services to his client who, in fact, had died.
• Faith Shelmon, 57, of Los Angeles, who submitted false claims totaling $4,487 for services to her husband who, in fact, had died.

Brown also filed charges against Richard F. Villegas, 38, of Downey, who submitted false claims totaling $13,243. He forged the signature of his deceased father, who was his in-home healthcare worker. He is also facing one count of grand theft and one count of presenting false Medi-Cal claims.

Defendants will be sent a letter ordering them to surrender to the court in June. If they fail to appear, an arrest warrant will be issued. If convicted, the defendants could face one year in county jail to five years in state prison.

An example:
Larry Denman had been paid by In-Home Supportive Services to provide care for his mother, Lillie Denman. On March 4, 2007, she was admitted to St. Francis Medical Center. On March 23, she was transferred to a convalescent home and died the next day.

The investigation found that Denman billed In-Home Supportive Services for providing 385 hours of homecare to his mother while she was hospitalized and for nearly a month after her death. Denman forged his mother’s signature to obtain payment.

"The strong, appropriate actions taken in these IHSS fraud cases are a direct reflection of the team effort among DHCS and the Attorney General's Office to protect those being defrauded and prosecute the offenders to the fullest extent allowed by law,' said DHCS Director David Maxwell-Jolly.
DHCS works closely with the Attorney General's Office to prevent, detect and investigate Medi-Cal provider and beneficiary fraud.

The $40 billion Medi-Cal program receives 50 percent of its funding from the state and 50 percent from the federal government. One in 6 California residents is a Medi-Cal beneficiary.

As part of his effort to combat Medi-Cal fraud over the past few months, Brown has:

• Filed suit against seven private laboratories to recover hundreds of millions of dollars in illegal overcharges for blood tests and other laboratory procedures.

• Filed criminal charges against six individuals who paid healthy seniors to be admitted to a hospice for the terminally ill and then billed state and federal health care programs $9 million for procedures that were never performed.

• Arrested two individuals who filed false claims totaling $1.34 million to Medicare for medical services that were never performed.

To report fraud or abuse, call the Attorney General’s Office (Bureau of Medi-Cal Fraud and Elder Abuse) at (800) 722-0432.

The complaints are attached.

# # #
AttachmentSize
Allen-Jones.pdf5.5 MB
Lee-Rogers.pdf4.08 MB
Shelmon-Woods.pdf4.72 MB

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