MANILA, Philippines – Filipinos were among 42 suspects arrested on Thursday for being part of a group that defrauded health care provider Medi-Cal nearly $4.6 million or more than P222 million, according to the US Department of Justice.
Federal and state authorities arrested 20 defendants who are among 42 defendants named in a 41-count indictment and part of a two-year investigation called Operation License Integrity conducted by the Federal Bureau of Investigation, the US Department of Health and Human Services Office of Inspector General, and the Office of the California Attorney General-Bureau of Medi-Cal Fraud and Elder Abuse.
The Filipinos were accused of being part of a ring that defrauded Medi-Cal out of nearly $4.6 million by using unlicensed individuals to provide in-home care to scores of disabled patients, many of them children with cerebral palsy or developmental disabilities.
“We believe that this is the largest single case alleging Medi-Cal fraud ever filed in the state,” said United States Attorney Thomas P. O’Brien. “The nearly four dozen people associated with this fraud ring not only cheated taxpayers, they endangered the lives of young people they promised to protect and care for.”
The Filipina organizer Priscilla Villabroza, a registered nurse who ran a Santa Fe Springs-based company called Medcare Plus Home Health Providers, pleaded guilty in federal court last year to five counts of health care fraud.
According to court documents, Villabroza and others hired individuals to provide care to disabled Medi-Cal patients, many of whom were children and young adults served under a program called Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Supplemental Services.
The indictment alleges that from August 2004 through the end of 2007, Villabroza and others hired unlicensed individuals to provide services to the disabled Medi-Cal patients and billed Medi-Cal as if they were licensed vocational nurses (LVNs).
Some of the unlicensed individuals had foreign training, but never passed a nursing exam here. Some of them had no medical training at all.
The unlicensed nurse defendants visited the patients at home and at school and provided nursing services that included administering medications, adjusting ventilators, and feeding through gastronomy tubes. Some parents and patients reported to authorities that the “nurses” lacked basic skills.
In one case, a “nurse” was unable to replace a tracheotomy tube that had fallen out of a young patient’s neck. In another case, an impostor nurse simply fled a medical situation when she apparently was unable to provide assistance.
“Villabroza and her associates concocted a clever rip-off where they hired untrained and unlicensed nurses to provide care to children with serious health conditions,” California Attorney General Edmund G. Brown Jr. said. “At a time of budgetary crisis, they cheated California’s welfare system and pocketed millions of dollars in unauthorized state reimbursements.”
Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the Office of Inspector General for the Department of Health of Human Services, stated: “Today’s arrests send a strong message to those who would corruptly take advantage of the Medi-Cal system. Greed, at the expense of our most vulnerable citizens and their quality of care, will not be tolerated. The Office of Inspector General will continue to closely work with our Federal, State and local law enforcement partners to prevent, deter and prosecute health care fraud.”
A key assistant to Villabroza – Susan Bendigo, a Filipino nurse who ran a Medcare Plus subsidiary – was indicted last year. Bendigo is a fugitive who fled the United States during the investigation into her activities.
Villabroza, Bendigo and supervisors involved in the scheme allegedly directed the unlicensed nurse defendants to lie about their licensing and qualifications by telling the parents or guardians of the disabled Medi-Cal beneficiaries that they were LVNs, according to the indictment.
The unlicensed nurse defendants falsely presented themselves as professionals, concealed their unlicensed status from the parents or guardians of the disabled Medi-Cal beneficiaries, and in some cases affirmatively misrepresented themselves as LVNs.
The defendants arrested were expected to make their initial appearances in United States District Court in Los Angeles. The other defendants named in the indictment will be summoned to appear in court for arraignments in the coming weeks.
All of the defendants named in the indictment are charged with conspiracy to commit health care fraud, a felony count that carries a statutory maximum penalty of 10 years in federal prison. They were all named in at least one substantive count of health care fraud, a charge that carries a maximum statutory penalty of 10 years in federal prison.
