2009 Idaho News Archive
News Archive: 2012 | 2009
December 3, 2009 - Two Convicted for Health Care Fraud - Read More
August 10, 2009 - Washington Resident Sentenced to Thirty Months for Defrauding Idaho’s Medicaid Program - Read More
Two Convicted for Health Care Fraud (U.S. Attorney for the District of Idaho)
Ronald Bret Hamilton, 49, of Pocatello, and Vanessa Cattanea, 36, of Charleston, West Virginia, were convicted on Dec. 2, 2009 by a federal jury in Pocatello, Idaho, on multiple counts of health care fraud, announced the U.S. Attorney’s Office. The jury returned guilty verdicts late Wednesday evening, finding Hamilton guilty on 55 of 72 counts and Cattanea guilty on 76 of 84 counts.
During the nine-day trial, the jury heard evidence that Hamilton was the owner and Cattanea the treatment director for Teton Family Services, a company that offered partial care for children. Teton operated clinics in Pocatello, Blackfoot and American Falls. The evidence showed that Hamilton and Cattanea knowingly and fraudulently billed Medicaid in excess of $250,000 for services provided away from the clinic, including trips to Yellowstone National Park, Bear Lake, and Salt Lake City, and for services provided by unlicensed staff.
Sentencing is set for February 22, 2010, at the United States Courthouse in Pocatello, Idaho. Hamilton and Cattanea each face a maximum sentence of ten years in prison on each count.
This case was jointly investigated by the U.S. Department of Health and Human Services, Office of Inspector General, and Idaho Department of Health and Welfare.
For more information, visit the website of the United States Attorney's Office for the District of Idaho; http://www.justice.gov/usao/id/
Washington Resident Sentenced to Thirty Months for Defrauding Idaho’s Medicaid Program (U.S. Attorney for the District of Idaho)
Candace Elmer, 53, of Spokane, Washington, was sentenced on Thursday in Coeur d’Alene to 30 months in federal prison for defrauding Idaho’s Medicaid program, the United States Attorney’s Office announced. U.S. District Judge Edward J. Lodge also ordered Elmer to serve three years of supervised release after she completes her prison term. Judge Lodge ordered Elmer to pay $217,279.18 in restitution for payments she unlawfully billed to Medicaid. Elmer entered a guilty plea in August 2008.
The investigation began in 2005 when the Idaho Department of Health and Welfare received information indicating that Elmer, then manager of Behavioral Intervention Services (“BIS”), was providing Psychosocial Rehabilitation services (“PSR”) to children and adults in North Idaho that did not conform with Medicaid requirements. PSR is mental health treatment designed for severe mentally and emotionally disturbed children and adults. PSR services are routinely provided by independent providers who bill Medicaid for the services they provide. Providers must meet several Medicaid requirements in order to qualify for payment.
Following complaints by clients of BIS, the Idaho Regional Mental Health Authority reported the case to the Idaho Medicaid Fraud Unit. A subsequent investigation by the Fraud Unit and United States Department of Health and Human Services Office of Inspector General revealed that Elmer had submitted false applications to Medicaid which enabled BIS to bill Medicaid for PSR services, that these services were purportedly provided to clients by BIS employees who were not qualified to provide those services, and that BIS was billing Medicaid for services not provided. In ordering restitution, Judge Lodge stated that the $217,279.18 amount was a “conservative” estimate of the total fraud committed by Elmer as demonstrated by the government.
U.S. Attorney Tom Moss praised Health and Welfare, the Idaho State Office of Attorney General, and Health and Human Services Office of Inspector General. “I am grateful that state and federal law enforcement have made it a priority to investigate those who exploit a program designed to serve some of the most vulnerable and desperate people in our community. The efficacy of this program is built upon trust between Medicaid and its service providers, which is also exploited by such fraud. The effect of state and federal law enforcement teaming together is apparent in cases like this one. Ms. Elmer will no longer exploit those in need of PSR services and Ms. Elmer will no longer steal state and federal tax dollars. Prison is especially appropriate given Ms. Elmer’s reckless disregard for people in need of PSR services and the substantial amount of money she stole from Medicaid through fraud and deceit.”