2 from Athens charged with TennCare fraud; Is this the best Tennessee can do?

Posted: Dec 16, 2008 05:18 PM CST


NASHVILLE (WATE) -- A man and woman from Athens have been charged with 2 from Athens charged with TennCare fraud

Posted: Dec 16, 2008 05:18 PM CST
NASHVILLE (WATE) -- A man and woman from Athens have been charged with TennCare fraud in separate cases.

John V. Davis, 25, is charged with three counts of using TennCare to get controlled substances by doctor shopping.

According to the indictment, Davis failed to disclose to his doctor that he'd seen other doctors within a 30-day period, receiving prescriptions for the painkillers Oxycodone and Hydrocodone.

Investigators say Davis received a prescription for Oxycodone during a visit to a hospital emergency room, which was paid for by TennCare.

They also say Davis used TennCare twice to pay for prescriptions for Hydrocodone.

Kristie Smithers, 31, is charged with three counts of TennCare fraud for using it to pay for fake prescriptions.

Smithers is accused of using TennCare to pay for fake prescriptions written for Hydrocodone three times.

If convicted, each could each spend up to two years per charge in prison.

Banks Are Uniquely Positioned to Prevent Health Care Fraud

How about Banks assist with Health Care Fraud? Perfect example is NCFE missing the Founder and CEO and also an "Executive" James K Happ.....the person who assisted GW Bush's ex-partner Richard Rainwater in the "PONZI SCHEME" as noted by Federal Prosecutors involved in the case they would like to to reference as "an end to an era".

Not so fast.....so much more to KNOW! James K Happ....(Smoking GUN)


Banks Are Uniquely Positioned to Prevent Health Care Fraud
By Matt Squire


Bank compliance professionals are in a prime position to uncover health care fraud if they are aware of the tell-tale signs and report the related suspicious activity to law enforcement, say fraud investigators.

Health care fraud accounts for around 10 percent or $100 billion of the $1 trillion spent annually in the health care industry, according to the U.S. Government Accountability Office.

Since Poulsen's trial is now set to begin Oct. 1, it pushes the trial of James K. Happ, another former National Century executive....

Now why is this delay for Happ occurring? After the NOVEMBER election of course. Does any reporter really know where Happ is form or what his job at NCFE really was? If so, no one has yet to connect the dot!
Who does Happ really know? (Hint: Bush Connection)
The former CEO of National Century Financial Enterprises Inc. has successfully put off his trial on fraud-related charges by two months.

A federal judge ruled Friday that Lance Poulsen, the leader of the Dublin-based health-care financing company before it collapsed in 2002, will begin facing charges of securities fraud and conspiracy on Oct. 1 instead of Aug. 4. U.S. District Court Judge Algenon Marbley granted Poulsen's July 7 continuance request after Poulsen's attorneys argued they needed more time to review 40 boxes of documents the government is scheduled to make available between now and August.

"A two-month continuance will ensure that Poulsen has the time to obtain and review the documents that he plausibly claims are central to his theories of defense," Marbley wrote in his July 11 order.

Since Poulsen's trial is now set to begin Oct. 1, it pushes the trial of James K. Happ, another former National Century executive, to Dec. 1. Poulsen and Happ have both pleaded not guilty.

Poulsen, 65, co-founded National Century in 1991, building it into a major health-care financing company. It specialized in buying receivables from medical providers at a discount, which gave the health-care businesses the quick cash they needed. The receivables were then packaged as asset-backed bonds and sold to investors.

But National Century fell into Chapter 11 bankruptcy six years ago. The Justice Department alleged Poulsen and other executives ran a sophisticated Ponzi scheme that bilked investors out of nearly $2 billion. Poulsen pleaded not guilty to charges of conspiracy, securities fraud, wire fraud, money laundering conspiracy and concealment of money laundering.

Five other former National Century executives were found guilty in March of running a multiyear securities fraud at National Century. Poulsen was scheduled to go on trial with them, but his day in court on those charges was delayed because the government also accused him of trying to tamper with a witness.

Shortly after the March convictions of the five executives, Poulsen stood trial on the witness tampering charges. A jury found him and an associate, Karl Demmler, guilty of trying to bribe a government witness who is planning to testify against Poulsen in his securities fraud trial.

Hmm.........WHERE IS THE OUTRAGE?

The Washington Post says that experts are concerned about the growing problem of health care fraud, which is estimated to cost taxpayers over $60 billion each year.

The article notes that Medicare automatically pays most provider bills that are submitted with federally issued supplier numbers. The audit systems focus on overbilling and unorthodox treatment rather than fraud.

These circumstances allowed a high school dropout using a laptop computer to bilk the federal government out of $105 million.

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federal appeals court in Denver has reinstated a lawsuit

Nurses demand increase in staffing at Centerpoint
By JULIUS A. KARASH
The Kansas City Star

Nurses at Centerpoint Medical Center in Independence said Thursday that the hospital needs to beef up staffing to ensure patient safety.

Nurses United for Improved Patient Care, a union that represents Centerpoint nurses, said the nurses made their case in a petition to the hospital, which is part of HCA Midwest Health System.

Uriah Magill, an intensive care nurse at Centerpoint, said care suffers when he and his colleagues are forced to look after too many patients at once.

“As the care provider, it is very frustrating and concerning when the patient needs care and we can’t provide that to them because we are overworked and overloaded,” Magill said.

The union noted that Centerpoint scored worst among area hospitals in key patient ratings reported recently by the federal government.

HCA Midwest spokeswoman Sara Smith said Centerpoint is in contract negotiations with Nurses United.

“Unions often use press releases of this nature in an attempt to use leverage in bargaining. Centerpoint is dedicated to quality patient care, and staffing levels are determined based on the needs of our patients on a daily basis,” she said.

Smith acknowledged that Centerpoint needs more nurses than the 300-plus who are currently on staff. She said the hospital is successfully recruiting new nurses amid a nationwide nursing shortage.

HCA Midwest, which is based in Kansas City, is part of Nashville-based HCA Inc.

In a separate matter, a federal appeals court in Denver has reinstated a lawsuit claiming that Wesley Medical Center in Wichita and other HCA hospitals had endangered patients through inadequate medical and nurse staffing.

The case involved patient Joseph Spires, who died at Wesley in 2004. The plaintiffs said HCA had developed a computer software program that led to inadequate staffing at Wesley and other HCA hospitals.

A federal court in Wichita earlier had dismissed the would-be class action lawsuit.

“This case is without merit and is not about patient care,” HCA spokesman Ed Fishbough said Thursday.


To reach Julius A. Karash, call 816-234-4918 or send e-mail to jkarash@kcstar.com.

INDICTMENTS ..Connect this to Largest Bankruptcy in Tennessee

PressZoom) - COLUMBUS – A federal grand jury here today returned a superseding indictment charging eight former executives of National Century Financial Enterprises ( NCFE ) with conspiring to defraud investors by diverting millions of dollars in investors’ funds, fabricating data in investor reports, and moving money back and forth between accounts in order to conceal investor fund shortfalls. NCFE, based in Dublin, Ohio, was one of the largest healthcare finance companies in the United States until it filed for bankruptcy in November, 2002.



Gregory G. Lockhart, United States Attorney for the Southern District of Ohio, J. Mark Batts, Acting Special Agent in Charge, Federal Bureau of Investigation, Cincinnati Field Division; Gerald A. O’Farrell, Assistant Inspector in Charge, U.S. Postal Inspection Service; Jose Gonzalez, Special Agent in Charge, Internal Revenue Service Criminal Investigation, and Brian M. Moskowitz, Special Agent-in-Charge of the U.S. Immigration and Customs Enforcement ( ICE ) Office of Investigations in Detroit announced the superseding indictment.



The 27-count indictment alleges conspiracy, securities fraud, wire fraud, money laundering, and money laundering conspiracy. The indictment also seeks $1.9 billion in forfeiture of property representing the proceeds of the conspiracy.

Named in the indictment are:

* Lance K. Poulsen, of Port Charlotte, Florida. Poulsen served as President, Chairman, Chief Executive Officer and an owner of NCFE.

* Donald H. Ayers, of Fort Myers, Florida, was the Vice Chairman, Chief Operating Officer, Director and an owner of NCFE.

* Rebecca S. Parrett, now in Carefree, Arizona, was the Vice Chairman, Secretary, Treasurer, Director and an owner of NCFE.

* Randolph H. Speer, now residing in Peachtree City, Georgia, was NCFE’s Chief Financial Officer.

* Roger S. Faulkenberry, now residing in Dublin, Ohio, was responsible for raising money from investors through the sale of notes.

* Jon A. Beacham, now residing in Grosse Pointe, Michigan, was also responsible for raising money from investors through the sale of notes.

* James E. Dierker, now residing in Powell, Ohio, was Associate Director of Marketing and later Vice President of Client Development at NCFE.

* James K. Happ, of Palm Beach Gardens, Florida, was a Certified Public Accountant, Vice President of Servicer Operations and later Executive Vice President for Servicer Operations.



NCFE funded healthcare providers by purchasing their accounts receivable, then providing them with cash they could use to pay operating expenses right away. NCFE raised funds by selling asset-backed notes to institutional investors. Investors received regular interest payments and a lump-sum payment when the notes were retired.



The indictment alleges that the defendants sold notes to investors with an aggregate value of $4.4 billion between May, 1998 and May, 2001.

The indictment alleges that instead of investing the funds in the purchase of high quality accounts receivable as promised, the defendants diverted the funds to healthcare providers, many of whom they owned in whole or in part, creating shortfalls in account balances. They allegedly fabricated data in investor reports, double-counted money by moving it back and forth between funds, made other false statements, and loaded false data into the accounting system in order to conceal the shortfalls.



The indictment alleges that the defendants created a false and misleading picture of NCFE as a healthy, growing company in order to boost their own salaries and income.



The maximum penalty for each count of money laundering, money laundering conspiracy and wire fraud is 20 years imprisonment and a $500,000 fine. The conspiracy to violate statutes of the United States count and securities fraud counts carries a maximum penalty of five years imprisonment and a $250,000 fine.



All defendants, except for Happ, were initially indicted in May, 2006. United States District Judge Algenon L. Marbley will preside over the case which is scheduled for trial on November 5, 2007. The government does not anticipate that this superseding indictment will delay the trial.



“Large and small investors should have clear and accurate pictures of a company’s financial performance,” Lockhart said. “Today’s superseding indictment seeks to hold another individual accountable for his role in the case and streamlines the charges against the previously indicted defendants.”



Lockhart commended the cooperative investigation by the agents and inspectors of the FBI, U.S. Postal Inspection Service, IRS Criminal Investigation, and ICE. He further commended Assistant U.S. Attorneys Dale E. Williams, Jr., and Doug Squires, as well as Trial Attorneys Leo Wise and Jeffrey A. Neiman, U.S. Department of Justice, Criminal Division, Fraud Section, who are prosecuting the case.



An indictment is merely an accusation. All defendants are presumed innocent of the charges and it is the government’s burden to prove a defendant’s guilt beyond a reasonable doubt at trial.


CONTACT: Fred Alverson
614-469-5715
FAX : ( 614 ) 469-5503