Federal prosecutors secured indictments against 8 more former employees of Long Beach, California based Atlantic Health Services, formerly known as Atlantic Recovery Services (ARS) for health care fraud and aggravated identity theft for their alleged participation in a scheme that prosecutors claim resulted in the submission of more than $50 million in fraudulent bills to a California state program for alcohol and drug treatment services for high school and middle school students that in many instances, were not provided or were provided to students who did not have substance abuse problems. Download Drug Counseling Scam Indictment. 

The latest in the ongoing series of charges brought by federal officials resulting from investigations into charges made by ARS, the indictments accuse ARS and its employees of engaging in a long-running fraud scheme to steal tens of millions of dollars from a program with limited resources that was designed to help underprivileged youth in recovery.  In the process, prosecutors claim the defendants and ARS branded many innocent young people as substance abusers and addicts in order to boost enrollment numbers and billings.

Prosecutors claim ARS received more than $46 million from California’s Drug Medi-Cal program after ARS submitted false and fraudulent claims for group and individual substance abuse counseling services.  All 8 defendants are former employees of ARS, which received contracts to provide substance abuse treatment services through the Drug Medi-Cal program to students in schools in Los Angeles County.  The schools included various sites operated by Soledad Enrichment Action and public schools in Montebello, California, Bell Gardens, Californina, Lakewood, and the Antelope Valley.

According to the indictment unsealed this morning, the claims submitted by ARS to the Drug Medi-Cal program were false and fraudulent for a number of reasons, including:

• ARS billed for services provided to students who did not have substance abuse disorders or addictions and therefore did not qualify to receive Drug Medi-Cal services;
• ARS billed for counseling sessions that were not conducted at all;
• ARS billed for counseling services that were not conducted in accordance with Drug Medi-Cal regulations regarding length, number of students, content and setting;
• ARS personnel falsified documents, including treatment plans, group counseling sign-in sheets, progress notes and update logs (which listed the dates and times of counseling sessions); and
• ARS personnel forged student signatures on documents.
• The defendants named in the indictment are:

• Lori Renee Miller, 54, of Lakewood, California, the program manager at ARS who supervised substance abuse recovery managers and counselors;
• Nguyet Galaz, 41, of Montclair, California, who oversaw services provided at approximately 11 schools in Los Angeles County;
• Angela Frances Micklo, 56, of Palmdale, California, who managed counselors at approximately nine schools in Los Angeles County, including several in the Antelope Valley;
• Maribel Navarro, 48, of Pico Rivera, California, who managed counselors at approximately ten schools in Los Angeles County;
• Carrenda Jeffery, 64, of the Mid-City District of Los Angeles, who managed counselors at approximately three schools;
• LaLonnie Egans, 57, of Bellflower, California, who managed counselors at three schools;
• Tina Lynn St. Julian, 51, of Compton, California, who worked as a counselor at two schools; and
• Shyrie Womack, 33, Egans’ daughter, also of Bellflower, who worked as a counselor at three schools.The indictments announced today raise the total former ARS employees charged as a result of an investigation by the Office of Inspector General of the Department of Health and Human Services; the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse; and IRS – Criminal Investigation of ARS to 20. Previously, 11 other defendants pleaded guilty to health care fraud charges stemming from the ARS scheme.  Those defendants are former ARS managers Cathy Fernandez, 53, of Downey, California; Erin Hoover, 37, of Long Beach, California; Elizabeth Black, 51, of Long Beach; Helsa Casillas, 44, of El Sereno, California; and Sandra Lopez, 41, of Huntington Park, California; and former ARS counselors Tamara Diaz, 45 of East Los Angeles, California; Margarita Lopez, 40, of Paramount, California; Irma Talavera, 27, of Paramount; Laura Vasquez, 52, of Pico Rivera; Cindy Leticia Ortiz, 29, of Norwalk, California; and Arthur Dominguez, 63, of Glendale, California.  Another defendant, Dr. Leland Whitson, 75, of Redondo Beach, California, the former Medical/Clinical Director of ARS, previously pleaded guilty to making a false statement affecting a health care program.   The dozen defendants who already pleaded guilty are pending sentencing by U.S. District Judge Philip S. Gutierrez.
• Each of the eight defendants named in the August 26 indictment unsealed today potentially faces decades in federal prison if convicted.  For example, if convicted, Miller faces a statutory maximum sentence of 324 years in federal prison.  Federal officials arrested six of the defendants today.  The Justice Department says it expects Galaz and Micklo self-surrender in the coming weeks.

With health care fraud enforcement a key component of the federal government’s efforts to bring down health care costs and the continuing success of federal and state health care fraud investigation and enforcement efforts like those already achieved by the Justice Department against the 12 defendants that already pleaded guilty, health care providers providing substance abuse or other treatments reimbursed by federal or state programs should must ensure that their care and billings are appropriately delivered and documented to withstand almost inevitable government scrutiny of their operations and activities.

For More Information Or Assistance

If you need assistance reviewing or responding to these or other health care related risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section, Board Certified in Labor & Employment Law, and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 26 years experience advising health industry clients about these and other matters. Her experience includes advising hospitals, nursing home, home health, rehabilitation and other health care providers and health industry clients to establish and administer compliance and risk management policies; prevent, conduct and investigate, and respond to peer review and other quality concerns; and to respond to Board of Medicine, Department of Aging & Disability, Drug Enforcement Agency, OCR Privacy and Civil Rights, Department of Labor, IRS, HHS, DOD and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns.  The scribe for the American Bar Association (ABA) Joint Committee on Employee Benefits annual agency meeting with the Department of Health & Human Services Office of Civil Rights,  Ms. Stamer has worked extensively with health care providers, health plans, health care clearinghouses, their business associates, employers, banks and other financial institutions, and others on risk management and compliance with HIPAA and other information privacy and data security rules, investigating and responding to known or suspected breaches, defending investigations or other actions by plaintiffs, OCR and other federal or state agencies, reporting known or suspected violations, business associate and other contracting, commenting or obtaining other clarification of guidance, training and enforcement, and a host of other related concerns.  Her clients include public and private health care providers, health insurers, health plans, technology and other vendors, and others.  In addition to representing and advising these organizations, she also has conducted training on Privacy & The Pandemic for the Association of State & Territorial Health Plans,  as well as  HIPAA, FACTA, PCI, medical confidentiality, insurance confidentiality and other privacy and data security compliance and risk management for  Los Angeles County Health Department, ISSA, HIMMS, the ABA, SHRM, schools, medical societies, government and private health care and health plan organizations, their business associates, trade associations and others.

A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  You can get more information about her health industry experience here. If you need assistance responding to concerns about the matters discussed in this publication or other health care concerns, wish to obtain information about arranging for training or presentations by Ms. Stamer, wish to suggest a topic for a future program or update, or wish to request other information or materials, please contact Ms. Stamer via telephone at (214) 452-8297 or via e-mail here.

If you or someone else you know would like to receive future updates about developments on these and other concerns from Ms. Stamer, see here.

About Solutions Law Press

Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns.

Other Helpful Resources & Other Information

We hope that this information is useful to you.   If you found these updates of interest, you also be interested in one or more of the following other recent articles published on the Coalition for Responsible Health Care Reform electronic publication available here, our electronic Solutions Law Press Health Care Update publication available here, or our HR & Benefits Update electronic publication available here.  You also can get access to information about how you can arrange for training on “Building Your Family’s Health Care Toolkit,”  using the “PlayForLife” resources to organize low-cost wellness programs in your workplace, school, church or other communities, and other process improvement, compliance and other training and other resources for health care providers, employers, health plans, community leaders and others here. If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail by creating or updating your profile here. You can reach other recent updates and other informative publications and resources.

Examples of some of these recent health care related publications include:

• Check Out & Comment By 10/13 On FDA Proposed Food Labeling Rule Changes
• 10 Practical Pointers To Use Law To Better Strengthen The Legal Defensibility Of Your Business & Its Leaders
• Check Defensibility Of Policies & Practices Given New HHS/DOJ Joint Disability Law Technical Assistance
• 10 Year Prison Sentence. $8M Civil Settlement Highlight Risks Of Wrongfully Billing Services Performed By Nonphysicians As Physician Services
• New HIPAA Settlement Highlights Internet Applications Safeguards, Whistleblower & Management Oversight Compliance Risks
• McGraw Appointed New OCR Deputy Director
• Tex Docs Urged To Support Medical Board Reforms
• CMS Proposes New Quality Measures, Reporting, Other Changes For FY 2016 Psych Facilities Prospective Payment SYstem Updates
• Great Time To Remind Patients, Employees To Check Their Immunizations Are Up To Date
• CMS Issues Last Call For Comments, Questions On Proposed Medicare Home Health Billing Templates
• HHS Proposes Stage 3 Meaningful Use EHR Incentive Programs & 2015 Edition Health IT Certification Criteria Rules
• Health Care Employer’s Discrimination Triggers Medicare, EEOC Prosecutions
• Former Houston Area DME Owner To Serve 7+ Years, Pay $1.6 M In Restitution For Health Care Fraud
• Community Health Systems Professional Services Corporation & 3 Affiliated NM Hospitals Agree to $75 Million False Claims Act Settlement
• Manage Incentive Compliance
• Columbia to Pay $9 Million Plus To Settle DOJ/HHS False Claims Charges For Submitting Inaccurate Cost Reports and Mischarging Federal Grants
• OIG Warns Pharma Manufacturers to Prevent Copayment Coupon Use for Part D Drug Purchases
• 10/10 Kidney Foundation Professional Symposium Offers 7.5 Hours CME/CEUs
• Parkview Hospital To Pay $800K To Settle HIPAA Charges After Retiring Physician Blows The Whistle
• Whistleblower To Get $17M+ of Omnicare $124M False Claims Settlement
• Keeping Dementia Patients At Home:  New Study Gives Tips
• NHI Says Coordinated Care Can Reduce Disabled’s High ER Use; System Contains Many Barriers To Providing This Care
• Look At Mental Health Care For Part Of The Solution To Prevent A Future Newtown Tragedy
• 13 Employer Tips For Coping With Health Care Reform Now!

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile here. For important information concerning this communication click here.THE FOLLOWING DISCLAIMER IS INCLUDED TO COMPLY WITH AND IN RESPONSE TO U.S. TREASURY DEPARTMENT CIRCULAR 230 REGULATIONS.  ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, OR (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.

©2015 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press.  All other rights reserved.

This entry was posted on Thursday, September 3rd, 2015 at 3:11 pm and is filed under drug treatment, Health Care, Health Care Fraud, health care reimbursement, substance abuse treatment. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.