RPD Detective, Christian Vaughan CA DOJ Special Agent .

RPD Detective, Christian VaughanCA DOJ Special Agent, Craig Eastep

None of the faculty, planners, speakers,providers, nor CME committee membershave any relevant financial relationshipswith commercial interests.There is no commercial support for thisCME activity.

RPDOfficers responded to a call for serviceregarding possible elder abuse The location appeared to be a privateresidence used as a an assisted living facility The RP reported that he located his familymember inside the location The dependent had been transferred from TriCity Hospital, Hawaiian Gardens, withoutfamily members knowledge

RPlocated dependent inside location, withone other elder patient Both covered in feces, urine saturateddiapers, food bowl on floor One of the patients was trapped under heroverturned mattress, on the floor RP found no caregivers, readily available togive assistance, and immediately called 911 Caregivers eventually appeared when policearrived

Officersconfirmed the RP’s story and calledfor medical assistance Officers checked for other patients andfound 5 additional 5 of the 7 patients needed immediatemedical attention APS was notified to assist with placement Detectives called out, regarding possibleelder abuse and caregiver neglect

Detectivesinterviewed caregivers andcollected evidence On-site caregivers were unable to answerbasic questions regarding patient care Check of business license revealed fraudulentapplication to City Check of Secure Hands business revealedpossible fraudulent business/corporatelicensing for hospice, elder care facilities,and medical supplies

Basedon findings, a multi-agencycollaborative meeting was called to assistRPD with the investigation APSCADOJCCLCode Enforcement/Public Works Planof action was discussed Resources identified

8days after the investigation started, 4residents were still waiting for placement A male subject arrived at Secure hands in arental van The man was hired to remove the remainingresidents, and deliver them to anotherfacility located in Los Angeles The individual was intercepted by CodeEnforcement during a follow-up inspection Without intervention, the patients wouldhave been taken away without permission

ConfirmedSecure Hands was merely asubsidiary to a larger elder care “empire” 21 different businesses associated with SecureHands in the Los Angeles and Inland Empire areas HospiceHome HealthTransportationMedical SuppliesPharmacy (In process)

FraudElder Abuse – Minor to Violent CrimesDrug DiversionFacilities Enforcement TeamOperation Guardians

The billing of the Medi-Cal program forservices, drugs, or supplies that are: Unnecessary Not Performed or Provided More costly than those actually providedIncludes paying and/or receiving kickbacks forMedi-Cal billing referrals.

Crimescommitted by authorized providers ofmedical care, prescription medications andmedical equipment to Medi-Cal beneficiaries. Includes the diversion of narcotic prescriptionmedication

Investigateand prosecute elder abusecommitted against patients or residents.(Penal Code 368) Thesecrimes include assault, battery,burglary, financial abuse, rape, kidnappingand homicide.

Crimesagainst elders or dependant adultsthat occur in any place where two ormore people reside and receive assistancewith their activities of daily living (i.e.bathing, eating, toilet care). Examples include: Skilled Nursing Facilities,Hospitals, Board & Care Homes, ResidentialCare Facilities for the Elderly.

Patientbrought in with Stage 2/3 decubitusulcers, left with Stage 4 Died of septic shock 2 months later

Patientcomplained of significant knee painand asked for Dr. visit, but denied Leg amputated due to severe knee infection

Patient with untreated MRSAExtended In-Patient at local hospitalDischarge to licensed Adult Residential Facility(Riverside County)Transported to owners unlicensed facility (LosAngeles County) Patient bludgeoned to death inside facility

Bindersand documents found in SecureHands of most patients Hospice for patients seemingly not “dying” Same doctors authorizing hospice and homehealth All companies owned by same individuals HomeHealth for other patients Medicine provided by caretakers Rep Payee for Social Security

HomeHealth Care Hospice Social Security Other Social Programs

5500.00per month per patient Two 90 day periods Thereafter, 60 day periods Limitedhealth services provided Keep patients in “flop house” Low overhead MaximizeIncome

Openor buy a hospice Conspiring or complacent Dr. as MedicalDirector Marketers Medical Records Billers Submit claims If government starts investigating, movepatients out of county, new “flop house,”and new business.

IndependentSecure hands outcomeContractor’s who are paid perpatient (14107.2 HS, 550 PC, 750 IC) Hospice 500.00- 800.00 Per month for 3 months Home Health 500.00- 800.00One time or %

Elder AbuseAllegations

Two caretakers/on-site “medical staff”Each arrested for 5 counts of 368(b)(1) PC- ElderAbusePlead Guilty to one count and sentenced to 1year in jail.Both caregivers were on a “Travel Visa” and notauthorized to work. With their 2 children in the house. MiddleManager (RCFE AdministratorCertification) arrested for 6 counts of368(b)(1)- Elder Abuse Case pending

Owner(Licensed Nurse Practitioner)authorizing care and treatment Arrested and Charged with 6 counts of 368(b)(1)PC- Elder AbuseCase pending TwoRegistered Nurses providing care topatients Arrested and Charged with 2-3 counts of368(b)(1) PC- Elder AbuseCase pendingNeed to show that the RN’s knew patients were indeplorable conditions.

Joel Ombao, NP, OwnerBeverly Guerrero, RNRonnel Tiburcio,Marketer/ManagerCeleste Calma, CaregiverNimfa Molina, RNGilbert Calma, Caregiver

Kickback/BriberyAllegations

Co-Owner(Registered Nurse) authorizing andpaying kickbacks Arrested and Charged with 750(A) IC, 14107.2(B)WI- Variations of paying kickbacksCase pending 5Managers (Registered Nurses) authorizing,facilitating, and paying kickbacks Arrested and Charged with 750(A) IC, 14107.2(B)WI- Variations of paying kickbacksCase pending

13Marketers received cash for recruitingpatients. Arrested and Charged with 750(A) IC, 14107.2(A)WI- Variations of Receiving kickbacksCases pending

Gina CastromayorRN, OwnerMarianneLegaspiJCelsoOmbaoAlicia MarforiBrigita DeJesusJuliet MeerCamille OmbaoPercy GiesekeBilly BombardaJoelsonOmbaoJVoltaireOmbaoCynthia Castillo Belinda CatatocanMercedes GosiocoGrace TabarasRonnel Tiburcio,Marketer/ManagerLiset GarciaJocelyn Chavez

AssuranceHospice Care Solutions 360 Caresol RX Community Health Allied Services (Stockton) Dynamic Health Services SB Dynamic Health Services Grand Terrace Hospice Hospice Spectrum Hospice Spectrum Inland Empire Hospice Spectrum Lancaster LVNB Hospice (Las Vegas) MDNP Providers

SanBernardino Hospice Secure Hands Medical Supply Secure Hands Sherman Home Health Care Spectrum Hospice Joel Ombao, NP (Owner) Gina Castromayor, RN (Owner) John Thropay, MD (Medical Director) Stephen Levine, MD (Medical Director)

“National Health Care Fraud Takedown Results inCharges against 301 Individuals forApproximately 900 Million in False Billing” US DOJ,June 22, 2016 “In the Central District of California, 22defendants were charged for their roles inschemes to defraud Medicare of approximately 162 million. In one case, a doctor was chargedwith causing almost 12 million in losses toMedicare through his own fraudulent billing,including performing medically unnecessary veinablation procedures on Medicare beneficiaries.”US DOJ, June 22, 2016

Placingpatients in hospice fraudulently Home health companies fraudulent charges Inappropriate level of care for patients Licensing doesn’t match the level of careprovided Use of unlicensed facilities for patient“storage” Abuse of sales and distribution of medicalsupplies 17.5 Billion in Medicaid fraud nationally

Fraudagainst the Medicare and Medi-Calprograms Fraud against individual patients Neglect against the elderly or dependentadults DeathGreat Bodily InjuryIllnesses

Current Penal Code 368(a) definition(b) under circumstances or conditions likely toproduce great bodily harm. [Felony](c) under circumstances or conditions other thanthose likely to produce great bodily harm.[Misdemeanor] *(d) not a caretaker committing fraud against anelder [Wobbler](e) caretaker committing fraud against an elder[Wobbler] *

Penal Code 368 (c) under circumstances or conditions other than thoselikely to produce great bodily harm. [Misdemeanor] (2) Against residents of an unlicensed residential care facilityor unlicensed community care facilityWhile owning, managing, or operating[Felony]

Penal code 368 (e) caretaker or person who has a business relationshipcommitting fraud against an elder [Wobbler] If the elder or dependent adult is transported fromone residential location to another in furtherance ofthe fraud. [Felony]

Detective Christian Vaughan Riverside Police DepartmentFamily Justice Center3900 Orange AveRiverside, CA(951) 955-5233Cvaughan@riversideca.gov Special Agent Craig Eastep California Department of Justice1455 Frazee RdSte 315San Diego, CA 92108(619) 688-6842Craig.Eastep@doj.ca.gov

Questions regarding thisconference please contact:Steven BrownProject 23

PC- Elder Abuse Case pending Two Registered Nurses providing care to patients Arrested and Charged with 2-3 counts of 368(b)(1) PC- Elder Abuse Case pending Need to show t