Asian Journal- The Filipino-American Community Newspaper

THE United States Department of Justice (DOJ) Attorney Thomas P. O’Brien hails it as the single largest case of MediCal fraud ever filed in the state.

Officers arrested 20 people Thursday morning accused of being part of a medical fraud ring that defrauded the state millions of dollars and put the lives of children in danger.

DOJ official Thom Mrozek says the majority of those arrested and implicated in this case are Filipino.

"The majority of the defendants in this case are Filipino," said Mrozek, Public Affairs Officer for the DOJ to the Asian Journal. "Many of them are from the Philippines and are Philippine citizens. A number of the people arrested [Thursday] are here illegally."

The 20 defendants arrested Thursday morning are among 42 defendants named in a 41-count indictment that was returned by a federal grand jury on June 25.

The indictment alleges that a Santa Fe Springs nursing agency called Medcare Plus Home Health Providers would send out individuals and pose them as a licensed nurse to provide in home care to disabled patients and some cases children with cerebral palsy and other disabilities. The nursing agency would then bill Medi-Cal nearly $4.6 million for in-home licensed nursing services that were actually provided by unlicensed individuals, according to court papers.

The FBI and US Dept. of Health Services began investigating the Medcare Plus Home Health Providers after parents of the disabled children began complaining to authorities about the "nurses" lack of skill.

"We had one instance in which a child with a tracheotomy tube that was hooked up to a ventilator that helped him breathe, came out and the nurse simply didn’t know what to do, didn’t know how to handle it," said Mrozek. "Fortunately, the mother was there to get the tube back into place or else this child might have died."

In another case, an imposter nurse simply fled a medical situation when she apparently was unable to provide assistance, he added.

"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," said O’Brien.

The mastermind of the fraud ring, Priscilla Villabroza of Placentia, pleaded guilty to five counts of health care fraud last year. She’s facing more than 50 years in federal prison. 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.

Her assistant Susan Bendigo – who was also indicted last year - fled during the investigation. Authorities believe she’s hiding out in the Philippines.

Another key member of the fraud ring, 45-year-old Evelyn Briones Tisoy of Rowland Heights, was arrested Thursday morning. A KTLA news report said Tisoy was the administrator who sent out the fake nurses to unsuspecting homes.

"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."

In total, more than 42 will be arraigned and charged with fraud. Mrozek says about 80 percent of those are Filipinos.

Thursday’s arrest marks the end of the FBI’s two-year investigation into this matter. All 42-suspects will be arraigned sometime next week. All are charged with conspiracy to commit health fraud, a felony, that if found guilty, can land them in jail for the next 10 years. n

( www.asianjournal.com )

( Published on July 11, 2009 in Asian Journal Los Angeles p. A1 )