United Council on Welfare Fraud
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Hosted by UCOWF Welcome to the Wisconsin Association on Public Assistance Fraud From the Desk of the President Debby Vanderboom
We have reviewed the evaluations from the annual conference and overall, they were quite positive. Many of you enjoyed having filet mignon at the banquet. It appears the new owner of the Hotel Mead has made some very positive changes since our last conference. For all who enjoyed Nate Catura’s presentation I have contacted him requesting a return engagement. I guess the saddest part of all was the lower attendance. Approximately 20 less people attended this year, and it appears the new fraud plan, the consortiums, may have something to do with it. Only a couple people from consortium counties were represented. This was a concern of mine when presented with this new fraud concept and I fear WAPAF may not exist in the future because of it. Consortiums, are they good or bad for public assistance program integrity, including fraud. Over the past year many of you have been asking the WAPAF Board their opinions. I have tried to look at both the positive and negative of this new plan. I have come to the conclusion it is good for some and hurtful to others. For those counties who were doing little with program integrity or fraud investigation I think it can be a very positive program. Sharing resources, whether within a county or among counties, is definitely a cost effective measure. However, those counties that have had successful programs may be hurt by the idea of a consortium. I believe those counties will lose refunded dollars. One investigator assigned to numerous counties will be unable to accomplish what an individual counties’ program integrity unit can. For example, in 2007, the Waukesha County Public Assistance Fraud Unit completed over 200 investigations. The amount of fraud dollars equaled over $250,000.00! (That from one of the two wealthiest counties in the state with a low per capita public assistance caseload.) It has been said one must prioritize to get the “biggest bang for the buck”. Waukesha County does do that. The amount of fraud calls are well above the over 200 investigated cases. And, sometimes one must conduct some investigation into the allegation to determine whether it is financially feasible to complete a lengthy investigation. If Waukesha County were to enter into a consortium with several other counties, and assigned one investigator, I doubt these numbers would come close to what Waukesha County is presently accomplishing. (This, of course, is my opinion and not necessarily an opinion expressed by Waukesha County.) Therefore, I conclude that one must look at their individual county to determine what the consortium concept will accomplish for you. After all, we are responsible for the integrity of the taxpayer’s dollar! Please do not think your WAPAF Board of Directors is sitting silent. We have approached those responsible with our concerns. The Board of Directors will be meeting on Friday, July 11th. If there are comments or concerns you want addressed at this board meeting, please contact your Regional Director prior to this meeting. We are presently planning our one day Fall Training. It will be held Monday, October 20, 2008 at the Holiday Inn and Suites in Mosinee. Many in the WAPAF membership have requested training involving self-employment issues and we are trying to bring something together for you. Please watch for the Fall Training registration form later in the summer. Last, but not least, I would like to congratulate Jenni Dalton, Lead Worker in Economic Support from Marathon County, for receiving this year’s award from the WAPAF Board of Directors for her efforts to promote program integrity. Unbeknownst to Jenni, her supervisor assisted us with getting her to the conference so Jenni could accept her award. Thank you Jenni for all the work you do. Please remember this is a membership newsletter. We enjoy providing articles about “happenings” across the state. If there is something you wish to include in a future newsletter please e-mail Sandy Schlemm, our Newsletter Coordinator. Hopefully, you are staying dry and protected from our bumper crop of mosquitoes! Debby
And to those of you who purchased Make a Wish raffle tickets at the conference, thank you. Sue Rhode and I will be present at the drawing and will have our fingers crossed for a winner!
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WAPAF FALL TRAINING Monday October 20, 2008 Holiday Inn Mosinee
Please be advised that the State rate for rooms has increased to $ 70.00 per night **************************************************************** Elections will be held for directors in the odd numbered regions
WISCONSIN ASSOCIATION ON PUBLIC ASSISTANCE FRAUD, INC. 2008-2009 BOARD OF DIRECTORS
WAPAF Spring Conference Evaluations April 24 & 25, 2008
In general, this year’s Spring Conference received above average to excellent ratings. The following is a summary of the evaluations that were completed. HotelOther than 2 people not getting requested wake up calls, and two problems with reservations, everyone was pleased with the return to Hotel Mead. Meeting RoomMost people were pleased with the meeting rooms, although some people found the temperature in the rooms to be an issue. Conference RegistrationEveryone felt the conference registration process was excellent. Comment: “Directions from counties to place where conference is held.”
Child Support As It Relates To Public Assistance Fraud
Comments: “Excellent Speaker, a little low on volume.”
Social Security Documents and Identity Theft
Comments: “Would like presenter back to continue presentation items he was unable to cover.” “Longer presentation for this topic. More on how we can ID false id/illegal activities.”
Probation & Parole- A Valuable Resource for PA Fraud Investigations
Comments: “Would like presenter back to show websites used as to information you can receive.” “Very Interesting”
Stress Management
Comments: “Great presentation.” “Good to have something different.”
Introduction To BadgerCare Plus
Comments: “Handouts would have been helpful of power points. The handout provided did not cover overhead material which had more info.” “Very informational. Need to update on yearly basis. Hopefully they will return to conference.”
Fraud Program & Consortium Updates
Comments: “Should have had handouts.”
Conference in General
Suggestions for Future Trainings
For Immediate Release For More Information Contact: May 20, 2008 Kevin St. John 608/266-1221
DEPARTMENT OF JUSTICE EMPLOYEES FRANK REMINGTON, AL GUITIERREZ, AND RICH BASILIERE RECOGNIZED BY OFFICE OF INSPECTOR GENERAL FOR WORK ON COMPASSIONATE MOTHERS CASE Employees Honored For Work Leading to the Conviction of Five People For Medicaid Fraud
MADISON — Three Wisconsin Department of Justice employees were recognized today by the United States Department of Health and Human Services Office of Inspector General for their work on the Compassionate Mothers case that resulted in the conviction of five people for the fabrication of billing documents to support fraudulent Medicaid claims. Frank Remington, Al Gutierrez and Rich Basiliere were recognized today at a ceremony in Madison conducted by LaMont Pugh, on behalf of DHHS Inspector General Daniel Levinson. Pugh, the Special Agent in Charge of the DHHS Office of Inspector General’s Chicago Office of Investigations, presented the Department of Justice employees with the Inspector General Integrity Award, which is given in recognition of exemplary skills and dedication in fighting health care fraud. Frank Remington is an Assistant Attorney General at the Wisconsin Department of Justice. Prior to joining the Department of Justice in 1988, Remington clerked with the Wisconsin Supreme Court and spent two years in private practice. He currently prosecutes Medicaid fraud and health care crimes for DOJ. Remington is also active in the State Bar of Wisconsin, currently serving on the Board of Governors. Al Gutierrez is an investigator with the Medicaid Fraud Control Unit of the Wisconsin Department of Justice. Gutierrez joined the Department of Justice in 2003, after serving for over 25 years with the Milwaukee Police Department as a law enforcement officer, including work as a detective in the criminal investigation bureau and the vice control division. Rich Basiliere is also an investigator with the Medicaid Fraud Control Unit of the Wisconsin Department of Justice, joining the Department in 2005. Prior to that, Basiliere was involved in the investigation of public assistance fraud at the county level for over 10 years. Basiliere served as a board member and president of the Wisconsin Association of Public Assistance Fraud. “The lawyers and investigators of the Medicaid Fraud Control Unit investigate and prosecute fraud and elder abuse every day,” Attorney General J.B. Van Hollen said. “I am proud to see Frank, Al, and Rich honored for their hard work on a very large and significant case. They deserve it.” The Department of Justice prosecuted a series of cases regarding Compassionate Mothers Inc. Nicole Stewart founded Compassionate Mothers Inc. in 2003, and stated its purpose was to provide prenatal care coordination and childcare coordination for pregnant mothers or mothers with newborns less than eight months who were eligible for the Medicaid or Badgercare Program. Between September 2004 and March 2006 Stewart billed Medicaid for services that had not been provided. In March 2006 the Department of Health and Family Services notified Stewart that it was going to conduct an audit of the business. Lacking any proof to support the billings to the Medicaid Program, Stewart paid her employees to fabricate documents in an attempt to cover up the fraudulent billings. The defendant created documents in an effort to make it appear that services were provided when, in fact, none had ever been. In addition to the cover up and billing for services that had never been provided, the complaint alleges that Stewart knowingly billed the Medicaid Program for services that had been provided but were not eligible for reimbursement under the Medical Assistance Program. On October 22, 2007, Stewart pleaded guilty to four counts of felony Medical Assistance Fraud. Additional charges of Medical Assistance Fraud were read-in for purpose of sentencing. The additional charges stem, in part, from a separate criminal complaint filed on September 18, alleging Stewart violated conditions of bail by starting another company called Care and Comfort Support Services and using that company to file false claims to the State’s Medicaid program. Nicole Stewart was sentenced to 5 years confinement, 9 years extended supervision and 3 years probation to be served consecutively, with $320,603 owed in restitution. In July 2007, three of the employees who assisted Stewart in creating the false documents each pleaded guilty to one misdemeanor count of filing fraudulent insurance claims. At an October 16, 2007, hearing, Judge Sosnay withheld a sentence and placed each defendant on one year probation. As a condition of probation, each defendant was ordered to pay $1,500 in restitution and a $1,000 fine. A fourth employee, Shirlaine Baker, pleaded guilty in March 2007 to one misdemeanor charge and was ordered to pay $1,500 in restitution. The Medicaid Fraud Control Unit served as lead investigators and prosecutors of the case. The Department of Health and Human Services – Office of Inspector General also provided investigative support. The Medicaid Fraud Control Unit of the Wisconsin Department of Justice investigates and prosecutes the abuse and neglect of elderly and others who receive Medicaid. It also investigated Medicaid billing fraud.
NEWS RELEASE
For Immediate Release For More Information Contact: April 29, 2008 Kevin St. John 608/266-1221
WAUKESHA COUNTY RESIDENT GUILTY OF TAX AND PUBLIC ASSISTANCE FRAUD MADISON — Soha Shanaa, a Waukesha County resident, was sentenced yesterday on two felony counts of filing a false and fraudulent tax return and one count of public assistance fraud based on a failure to notify authorities of a change of facts, Attorney General J. B. Van Hollen announced today. Waukesha County Circuit Court Judge Linda M. Van De Water sentenced Shanaa to 5 years probation and 12 months in jail as a condition of probation. In addition, she was also ordered to make restitution and comply with certain record keeping requirements related to operation of her business. Shanaa was sentenced after being found guilty upon entry of a plea to the charges. According to the complaint, Soha Shanaa and her husband, Elfatih Ibrahim, operated a business known as Midtown Shell Mart, in Wauwatosa, Wisconsin. While conducting an investigation of allegations of sales tax fraud, Department of Revenue investigators concluded that Shanaa had underreported income, resulting in an evasion of state income taxes between 2004 and 2005 of $10,802. Further, investigation by Waukesha officials revealed that Shanaa provided false information regarding their income in their applications for medical assistance. Shanaa and her family received medical assistance benefit to which they were not entitled in the amount of $15,595.04. “This is a case where the defendant both failed to make payments to the public treasury and raided it for benefits that she was not entitled to,” Van Hollen said. “We will continue to work with our state and local partners to investigate and prosecute fraud to protect the public treasury.” In a related case, Shanaa’s husband, Elfatih Ibrahim, age 43, has been previously charged in Dane County Circuit Court with filing a false and fraudulent tax return (one count) and theft of sales tax proceeds (two counts). That case is currently pending. The allegations in that matter have not been proven in a court of law. Ibrahim is presumed innocent, and the state bears the burden of proving his guilt beyond a reasonable doubt. The Wisconsin Department of Revenue, the Waukesha County Sheriff’s Department, and the Waukesha County Department of Human Services investigated this case. Waukesha County District Attorney Barbara Michaels and Assistant Attorney General Donald Latorraca represented the State of Wisconsin.
UCOWF
Just a reminder that if you attended the Spring conference,you automatically joined UCOWF ( United Council on Welfare Fraud ), the national organization. Membership dues were included in the cost of registration. This is something that the board of WAPAF voted to include in registration fees at each Spring conference. You can access their website at ucowf.org/index.html and explore the benefits of being a UCOWF member. There is a membership directory that will provide you with contacts in other states that can assist with investigations. Several of us have utilized this directory and it has proven to be very helpful. We are working on being included in UCOWF’s State organization link & will be able to post our newsletter and other announcements and information.
CERTIFIED WELFARE FRAUD INVESTIGATOR Some of our members took the test for Certified Welfare Fraud Investigator at a previous conference. We are willing to offer investigators the opportunity to take this test at a future conference or training. We will be discussing this more at the Fall Training, or you can contact the board member from your region.
WAPAF AWARDS We are again requesting nominations for someone who has shown extra effort in their efforts to promote program integrity throughout the state. The person that you nominate can be from all areas, ESS, Child Support, Law Enforcement, Investigation, or Prosecution. Please submit your nominations to: Mary Dick; Clark County Department of Social Services; 517 Court Street, Room 502; Neillsville, WI 54456-1976
WAPAF Award Nomination Form ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________
YOUR NAME__________________________________________AGENCY_____________________________________ ADDRESS:_____________________________________________________PHONE________________________
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