AGING AND DISABILITY SERVICES ADMINISTRATION

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  Case Referral Actions

The following information identifies prosecution activities during the months of January through March 2004, pertaining to suspected cases of Medicaid fraud referred to the Office of the Attorney General of Washington/Medicaid Fraud Control Unit by the Department of Social and Health Services.

KING COUNTY

State v. William Beck - On January 16, 2004, the defendant was sentenced to 30 days in jail converted to community service, $11,769 in restitution and another $500 in court costs. The defendant fraudulently billed Medicaid for services he did not provide. The defendant pled guilty to Theft in the First Degree on December 16, 2003. This matter was referred to the MFCU by the DSHS, Payment Review Program and Office of Financial Recovery.

King County V. Margiono - On 6 February 2004, Budhi Y. Margiono, a Certified Nursing Assistant at the Lake Vue Garden Convalescent Center, Kirkland, WA, pleaded guilty to Assault Fourth Degree. The violation stemmed from a report by the victim, a resident of the cited facility, that Margiono touched her in an inappropriate sexual manner during bathing. Margiono received an 18 month deferred sentence with 11 days credit for time served, 18 months probation and $840.20 in court costs. This incident was investigated by the Kirkland Police Department and prosecuted by the King County Prosecutors Office. This allegation was reported by the DSHS, Aging and Disability Services Administration, Complaint Resolution Unit.

State v. Brooks - Information alleging two counts of Medicaid False Statement was filed February 25, 2004, against Brooks for services paid for which she did not provide. Brooks continued to bill Medicaid claiming she was providing services to an individual who had died. Brooks received approximately $3,500 due to her fraudulent billing. This matter was referred to the MFCU by DSHS, Payment Review Program and Office of Financial Recovery.

State v. Dennis - Information alleging one count of Theft in the First Degree and one count of Medicaid False Statement was filed February 25, 2004, against Dennis for services paid for which she did not provide. Dennis continued to bill Medicaid claiming she was providing services to an individual who had been incarcerated. Dennis received approximately $2,000 due to her fraudulent billing. This matter was referred to the MFCU by DSHS, Office of Financial Recovery.

State v. Dominick - Information alleging one count of Theft in the First Degree and one count of Medicaid False Statement was filed February 25, 2004, against Dominick for services paid for which she did not provide. Dominick continued to bill Medicaid claiming she was providing services to an individual who had died. Dominick received approximately $4,000 due to her fraudulent billing. This matter was referred to the MFCU by DSHS, Payment Review Program and Office of Financial Recovery.

State v. Arruda - On March 23, 2004 the defendant pled guilty to one count of Theft in the First Degree and one count of Medicaid False Statement. The defendant billed Medicaid, for months, alleging she was providing services for a deceased client. Sentencing is set for April 23, 2004. This matter was referred to the MFCU by Evergreen Healthcare.

YAKIMA COUNTY

State v. Herrera - Information alleging one count of Theft in the First Degree was filed February 10, 2004, against Herrera for billing for hours not authorized. Herrera received approximately $12,000 due to her fraudulent billing. This matter was referred to the MFCU by Yakima Aging and Long Term Care.

PIERCE COUNTY

State v. Jones - Information alleging one count of Theft in the First Degree and one count of Medicaid False Statement was filed January 28, 2003, against Jones for services paid for which she did not provide. The defendant billed Medicaid, for over a year, alleging she was providing services for her developmentally disabled brother. Jones received approximately $10,000 due to her fraudulent billing. This matter was referred to the MFCU by DSHS, DDD, Region 5, Field Services.

SPOKANE COUNTY

State v. Stewart - Information alleging three counts of Medicaid False Statement was filed February 4, 2004, against Stewart for services paid for which he did not provide. The defendant billed Medicaid, for months, alleging he was providing services for a deceased client. Stewart received approximately $25,000 due to his fraudulent billing. This matter was referred to the MFCU by DSHS, Payment Review Program and Office of Financial Recovery.

State v. Cheryl K. Edlin - Information alleging four counts of Theft in the First Degree, two counts of Theft in the Second Degree, and three counts of Medicaid False Statements was filed on March 8, 2004.

The defendant and her husband provided unlicensed denturist services to patients at Inland Empire Denture/Dental Clinic and A New You Dental Clinic between 1999 and 2001. They then submitted the billing to DSHS claiming a licensed dentist had provided the services. The defendant and her husband received over $15,000 due to their fraudulent billing. This matter was referred to the MFCU by DSHS, Payment Review and Audit Section.

State v. Claude A. Edlin - Information alleging four counts of Theft in the First Degree, two counts of Theft in the Second Degree, and three counts of Medicaid False Statements was filed on March 8, 2004.

The defendant and his wife provided unlicensed denturist services to patients at Inland Empire Denture/Dental Clinic and A New You Dental Clinic between 1999 and 2001. They then submitted the billing to DSHS claiming a licensed dentist had provided the services. The defendant and his wife received over $15,000 due to their fraudulent billing. This matter was referred to the MFCU by DSHS, Payment Review and Audit Section.

KITTITAS COUNTY

State v. Carroll - Information alleging three counts of Medicaid False Statement was filed February 10, 2004, against Carroll for services paid for which she did not provide. Carroll received approximately $6,500 due to her fraudulent billing. This matter was referred to the MFCU by DSHS, Payment Review Program and Office of Financial Recovery.

SNOHOMISH COUNTY

State v. Morse - On March 2, 2004, the defendant pled guilty to one count of Theft in the Third Degree. The court sentenced the defendant to 365 days in jail suspended, 12 months probation, $4,900.00 in restitution and $500 in court costs. The defendant made full restitution prior to arraignment. This matter was referred to the MFCU by DSHS, Office of Financial Recovery.

State v. Austin - On March 17, 2004 the defendant pled guilty to one count of Medicaid False Statement. The court sentenced the defendant to 30 days in jail, converted to community service, and $700 in court costs. A restitution hearing is scheduled for May 7, 2004. The defendant was the owner/operator of Country Side Adult Family Home. This matter was referred to the MFCU by DSHS, Sky Valley Home and Community Services.

THURSTON COUNTY

State v. Mann - On February 24, 2004, the defendant pled guilty to one count of Medicaid False Statement. The court sentenced the defendant to 30 days in jail, converted to community service, and ordered her to pay $3,325.00 in restitution and another $700 in fines and costs. The defendant continued to bill Medicaid, for several months, alleging she was providing services for an individual who had been hospitalized. This matter was referred to the MFCU by DSHS, Complainant Investigator Glenda Specht.

WHITMAN COUNTY

State v. Hudkins - Information alleging nine counts of Theft in the First Degree was filed March 8, 2004,. Hudkins, the former owner of the St. John Pharmacy, billed for prescription medications he did not provide to patients. Hudkins billed the Medicaid program for approximately $300,000 worth of prescription drugs, even though records reveal the pharmacy did not have the expensive and specialized medications in stock. This matter was referred to the MFCU by DSHS, Payment Review and Audit Section.

** Note ** : The MFCU has a no cost, two hour interactive training presentation, which addresses provider fraud and elder abuse identification and reporting. If your department is interested in receiving this training please contact the MFCU at (253) 593-2154/2317/2262.