For Immediate Release - September 30, 2011

AG Coakley Announces 118 Criminal Indictments Against 10 Individuals in Connection with Four Medicaid Fraud Cases

AG’s Investigation Alleges That Individuals Defrauded the Medicaid Program by approximately $10 Million in Taxpayer Funds; Allegations include examples in which defendant billed the state for care provided to deceased patients, orchestrated widespread kic

BOSTON – Ten people and three companies have been indicted in connection with their involvement in four individual Medicaid Fraud investigations, for allegedly defrauding taxpayers and MassHealth of approximately $10 million, Attorney General Martha Coakley announced today.

The allegations include examples in which certain defendants billed the state for care provided to deceased patients, orchestrated widespread kickback schemes, or grossly mischaracterized the level of care needed for patients in order to overbill the MassHealth system.

The 118 indictments returned yesterday by a Special Statewide Grand Jury, a Suffolk Grand Jury, and a Bristol County Grand Jury, are the result of four major criminal investigations conducted by Attorney General Coakley’s Medicaid Fraud Division. Two individuals were arrested late yesterday. The first, Sharon Richardson, was arrested in Framingham and will be arraigned today in Framingham District Court. The second, Carl Smith, was arrested in Dorchester and will be arraigned today in Suffolk Superior Court.

The other defendants will be summonsed for arraignment at a date to be determined.

“Fraud committed against the Medicaid system is theft from taxpayers, plain and simple,” AG Coakley said. “It also takes away much-needed funds that are supposed to go to care for some of our most vulnerable patients. These criminal indictments allege separate fraudulent schemes, including the billing for services that were never provided, that we allege defrauded taxpayers of approximately $10 million.

The four alleged schemes that were indicted today were:

ADLIFE HEALTHCARE LLC 

A Special Statewide Grand Jury returned indictments against Sharon Richardson, age 55, of Framingham, her company Adlife Healthcare, LLC (Adlife), and Adlife employees Lisa Richardson-Miles, and Kali Geddes.  The indictments allege that Adlife and these individuals billed MassHealth approximately $5.5 million for services that were not provided.

Adlife is a Group Adult Foster Care (GAFC) provider to MassHealth with locations in Framingham, West Springfield, Dorchester and Hyannis.

The GAFC program provides at-home personal care services to MassHealth recipients.  The Attorney General’s Office began an investigation into Sharon Richardson and Adlife following a referral from the Board of Registration in Nursing. The AG’s investigation revealed that Adlife, through Richardson and Richardson-Miles, routinely billed MassHealth for services not rendered, including billing for deceased individuals and individuals who never received services.  The AG’s investigation also found that Richardson falsified records submitted to MassHealth, and Richardson, Richardson-Miles, and Geddes, a social worker, falsified and destroyed internal records.  These actions were taken to conceal Adlife’s failure to provide the services for which it billed, to disguise its clients’ ineligibility to receive services, and to get clients approved for services.   

Sharon Richardson is charged with False Claims (5 counts), Larceny Over $250 (2 counts), and Conspiracy (2 counts). 

Adlife is charged with False Claims (6 counts), and Larceny Over $250 (2 counts).

State Police assigned to the Attorney General’s Office arrested Richardson on Thursday at her Framingham residence. Richardson will be arraigned in Framingham District Court today.

Lisa Richardson-Miles, age 36, of Framingham, who performed billing for Adlife, is charged with False Claims (2 counts), Larceny Over $250 (1 count), and Conspiracy (2 counts), for her role in the fraudulent billing scheme, and for ordering the destruction of records to conceal Adlife’s failure to provide services. 

Kali Geddes, age 31, of Brighton, is charged with one count of violating the Medicaid False Claims Act by altering and directing other Adlife employees to alter records to conceal Adlife’s failure to provide services.

A Grand Jury returned the indictments against Adlife, Richardson-Miles and Geddes yesterday. All will be arraigned in Middlesex Superior Court at a later date.  The investigation into this scheme remains ongoing.

These charges are allegations, and the defendants are presumed innocent until proven guilty.

The case is being prosecuted by Assistant Attorney General Joshua Orr and was investigated by Investigator Lisa Bailey, both of the AG’s Medicaid Fraud Division.  Massachusetts State Police assigned to the Attorney General’s Office, Examiners from AG Coakley’s Computer Forensics Lab, Special Agents from the Boston Office of the United States Department of Health and Human Services Office of the Inspector General, and the Boston Office of the Federal Bureau of Investigations also assisted in this case.

PREVENTIVE MEDICINE ASSOCIATES 

A Suffolk Grand Jury returned indictments against Dr. Punyamurtula Kishore, age 61, of Brookline, his company Preventive Medicine Associates, Inc. (PMA), as well as three others charged in connection with allegedly running an intricate “kickback” scheme and fraudulently billing MassHealth nearly $3.8 million. Dr. Kishore, and Preventive Medicine Associates, are both individually charged with Medicaid Kickbacks (8 counts), and Medicaid False Claims (8 counts). 

Dr. Kishore owns and manages PMA, a network of 29 medical branches throughout Massachusetts, some of which include physician office laboratories. Based on the AG’s investigation, Dr. Kishore allegedly used bribes or “kickbacks”—taking several different forms—to induce sober house owners to require their residents submit to urine drug screens performed by PMA’s physician office laboratories a minimum of three times a week. Drug screens generally are billed to the MassHealth program at a price of approximately $100 to $200.  Dr. Kishore allegedly manipulated those business relationships to bill MassHealth for tens of thousands of “medically necessary” urine drug screen testing of Medicaid eligible residents.

The Grand Jury also returned indictments against the following individuals in connection with their involvement in Dr. Kishore’s scheme to defraud the Massachusetts Medicaid Program.

  • Carl Smith, age 65, of Dorchester, manager of New Horizon House, LLC, located in Dorchester, is charged with receiving Medicaid Kickbacks (one count).
  • John Coughlin, age 31, of Carver, president of Gianna’s House Inc., which operates several sober houses located in Wareham, New Bedford, and Sandwich, is charged with receiving Medicaid Kickbacks (one count).
  • Thomas Leonard, age 56, of Malden, the part owner and manager of the Marshall House, a sober house located in Malden, held in the name of the 18 Maplewood Malden Trust, is charged with receiving Medicaid Kickbacks (one count).

On September 20, 2011, State Police assigned to the AG’s Office arrested Dr. Kishore at his Brookline residence. He was arraigned the following day in Malden District Court on one count of Medicaid Kickbacks at which time he pleaded not guilty.  Bail was set at $150,000 and Dr. Kishore was ordered to surrender his passport and inform probation of any travel plans.  A Superior Court judge subsequently reduced Dr. Kishore’s bail to personal recognizance and ordered him released with monitoring of a GPS bracelet.  The investigation is ongoing.

Carl Smith, was arrested last night in Dorchester and will be arraigned today in Suffolk Superior Court.  The other defendants will be summonsed for arraignment at a date to be determined.

These charges are allegations, and the defendants are presumed innocent until proven guilty.

The case is being prosecuted by Assistant Attorney General Nancy Maroney and was investigated by Investigator Brian Robinson, both of the AG’s Medicaid Fraud Division. Massachusetts State Police assigned to the Attorney General’s Office, Examiners from AG Coakley’s Computer Forensics Lab, Special Agents from the Boston Office of the United States Department of Health and Human Services Office of the Inspector General, and investigators from the Massachusetts Insurance Fraud Bureau also assisted in this case.

DAVID BENSON & MITCHELL COUNSELING SERVICES

A Bristol County Grand Jury returned indictments against David M. Benson, age 48, of New Bedford, and his company, Mitchell Counseling Services of New Bedford, in connection with a scheme to defraud state Medicaid and Medicare of monies in excess of $160,000 for services not provided. Benson is charged with Larceny Over $250 (12 counts), and Medicaid False Claims (6 counts). Mitchell Counseling Services is also charged with Larceny Over $250 (12 counts), and Medicaid False Claims (6 counts).

 

Benson is a licensed independent clinical social worker in Massachusetts and is the sole manager of Mitchell Counseling Services which provides psychotherapy services for Medicaid and Medicare eligible patients as a QMB-only (Qualified Medicare Beneficiary) provider.  AG Coakley’s Medicaid Fraud Division began an investigation into Benson and his practice following a referral from the Executive Office of Health and Human Services after he was found to be the top QMB provider. Following an extensive investigation, the AG’s investigation revealed that Benson allegedly routinely billed for treatment that exceeded services provided in connection with six patients. Benson billed as though his patients were in need of acute care multiple times each week, when Benson’s patients were provided either minimal, or no therapy at all. The investigation into this scheme remains ongoing. 

The Grand Jury returned indictments yesterday against Benson and Mitchell Counseling Center. Both will be arraigned in Bristol County Superior Court in Fall River at a later date.

These charges are allegations, and the defendants are presumed innocent until proven guilty.

The case is being prosecuted by Assistant Attorney General George Zachos and was investigated by Investigator Joseph Shea, both of the AG’s Medicaid Fraud Division. Massachusetts State Police assigned to the Attorney General’s Office, and Special Agents from the Boston Office of the United States Department of Health and Human Services Office of the Inspector General also assisted in this case.

CAROLYN WETTERBERG 

The Special Statewide Grand Jury returned indictments against Carolyn Wetterberg, age 70, of Weymouth, for allegedly defrauding the State Medicaid Program and billing MassHealth in excess of $600,000 in services not provided.  Wetterberg is charged with Medicaid False Claims (12 counts), and Larceny by False Pretense (12 counts).

Wetterberg was the part owner and sole manager of Wetterberg Nursing Homes, Inc. d/b/a Pond View Nursing Facility (Pond View). Pond View was a 43 bed long-term care skilled nursing facility located in Jamaica Plain. Wetterberg, who held several executive titles at Pond View, was the only Director of Nursing during the entire existence of the corporation.  In June 2008, Pond View was shut down by the Massachusetts Department of Public Health due to poor quality of care to its residents. Residents were safely transferred to other appropriate facilities.

AG Coakley’s Medicaid Fraud Division began an extensive investigation into Wetterberg’s activities after receiving an anonymous tip.  Ultimately, the investigation focused on her use of Management Minute Questionnaire’s (MMQs) for resident patients.

Long term care facilities receive payment from Medicaid by filling out a Management Minute Questionnaire (“MMQ”) for each MassHealth resident. MassHealth pays each facility reimbursement for care that corresponds to each patient’s nursing-care needs.  The MMQ sets forth several categories of patient related care, such as mobility, continence, and eating assistance.  The resident is assigned a score for each individual category depending upon the care he or she requires (e.g. Independent, Assist, Totally Dependent).  Medical records are used to assess the appropriate MMQ scores. Using the total MMQ score, MassHealth assigns each resident a corresponding functional level which determines the rate of reimbursement for that resident.  The higher the score assigned to the recipient, the higher the amount the facility is reimbursed by Medicaid. 

The AG’s investigators revealed that when Pond View residents arrived at new facilities, many of their MMQ scores dropped substantially. The AG’s Office alleges that between 2003 and 2008, Wetterberg ran an ongoing criminal scheme to defraud MassHealth by intentionally inflating the MMQ scores of Pond View residents. 

In a comparison of Pond View records with records from several residents’ new facilities, investigators discovered that Wetterberg grossly exaggerated many of her resident’s disabilities. That comparison includes evidence that residents claimed by Wetterberg to be in need of assistance walking, were able walk independently; residents claimed by Wetterberg to be incontinent, were completely continent; and residents claimed by Wetterberg to need assistance eating, were able to eat independently. Through this scheme, authorities allege that Wetterberg defrauded MassHealth of approximately $600,000 for services not provided.  The AG’s investigation into this scheme remains active and ongoing.

The Grand Jury returned these indictments yesterday. Wetterberg is expected to be arraigned at a later date in Suffolk Superior Court.

These charges are allegations, and the defendant is presumed innocent until proven guilty.

The case is being prosecuted by Assistant Attorney General Casey Groff and was investigated by Investigator April Waterhouse, both of the AG’s Medicaid Fraud Division.

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Attorney General Coakley’s Medicaid Fraud Division works cooperatively with MassHealth and other state and federal agencies to prosecute fraud against the Massachusetts Medicaid program. In 2010, AG Coakley’s Medicaid Fraud Division recovered more than $66 million, breaking the previous record set in 2009 by more than $14.3 million. It marked the fourth consecutive year of increased recoveries. Based on the Medicaid Fraud Division’s budget and factoring the federal reimbursement rate for Medicaid fraud enforcement, the 2010 recoveries represent a return of $40 for every $1 invested. Individuals can contact the AG’s Medicaid Fraud Tip Line to report fraud or abuse at (617) 963-2360. This tipline is available 24-hours-a-day and is intended for calls pertaining to abuse or neglect of a Long-Term Care Facility resident or fraud committed by a Medicaid provider.

 

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