RPD Detective, Christian Vaughan

CA DOJ Special Agent, Craig Eastep

None of the faculty, planners, speakers,

providers, nor CME committee members

have any relevant financial relationships

with commercial interests.

There is no commercial support for this

CME activity.

RPD Officers responded to a call for service

regarding possible elder abuse

The location appeared to be a private

residence used as a an assisted living facility

The RP reported that he located his family

member inside the location

The dependent had been transferred from Tri

City Hospital, Hawaiian Gardens, without

family members knowledge

RP located dependent inside location, with

one other elder patient

Both covered in feces, urine saturated

diapers, food bowl on floor

One of the patients was trapped under her

overturned mattress, on the floor

RP found no caregivers, readily available to

give assistance, and immediately called 911

Caregivers eventually appeared when police

arrived

Officers confirmed the RP’s story and called

for medical assistance

Officers checked for other patients and

found 5 additional

5 of the 7 patients needed immediate

medical attention

APS was notified to assist with placement

Detectives called out, regarding possible

elder abuse and caregiver neglect

Detectives interviewed caregivers and

collected evidence

On-site caregivers were unable to answer

basic questions regarding patient care

Check of business license revealed fraudulent

application to City

Check of Secure Hands business revealed

possible fraudulent business/corporate

licensing for hospice, elder care facilities,

and medical supplies

Based on findings, a multi-agency

collaborative meeting was called to assist

RPD with the investigation

• APS

• CADOJ

• CCL

• Code Enforcement/Public Works

Plan of action was discussed

Resources identified

8 days after the investigation started, 4

residents were still waiting for placement

A male subject arrived at Secure hands in a

rental van

The man was hired to remove the remaining

residents, and deliver them to another

facility located in Los Angeles

The individual was intercepted by Code

Enforcement during a follow-up inspection

Without intervention, the patients would

have been taken away without permission

Confirmed Secure Hands was merely a

subsidiary to a larger elder care “empire”

21 different businesses associated with Secure

Hands in the Los Angeles and Inland Empire areas

Hospice

Home Health

Transportation

Medical Supplies

Pharmacy (In process)

Fraud

Elder Abuse – Minor to Violent Crimes

Drug Diversion

Facilities Enforcement Team

Operation Guardians

The billing of the Medi-Cal program for services, drugs, or supplies that are:

• Unnecessary

• Not Performed or Provided

• More costly than those actually provided

Includes paying and/or receiving kickbacks forMedi-Cal billing referrals.

Crimes committed by authorized providers of

medical care, prescription medications and

medical equipment to Medi-Cal beneficiaries.

Includes the diversion of narcotic prescription

medication

Investigate and prosecute elder abuse

committed against patients or residents. (Penal Code 368)

These crimes include assault, battery,

burglary, financial abuse, rape, kidnapping

and homicide.

Crimes against elders or dependant adults

that occur in any place where two or

more people reside and receive assistance

with their activities of daily living (i.e.

bathing, eating, toilet care).

Examples include: Skilled Nursing Facilities,

Hospitals, Board & Care Homes, Residential

Care Facilities for the Elderly.

Patient brought in with Stage 2/3 decubitus

ulcers, left with Stage 4

Died of septic shock 2 months later

Patient complained of significant knee pain

and asked for Dr. visit, but denied

Leg amputated due to severe knee infection

Patient with untreated MRSA

Extended In-Patient at local hospital

Discharge to licensed Adult Residential Facility

(Riverside County)

Transported to owners unlicensed facility (Los

Angeles County)

Patient bludgeoned to death inside facility

Binders and documents found in Secure

Hands of most patients

Hospice for patients seemingly not “dying”

Same doctors authorizing hospice and home

health

All companies owned by same individuals

Home Health for other patients

Medicine provided by caretakers

Rep Payee for Social Security

Home Health Care

Hospice

Social Security

Other Social Programs

$5500.00 per month per patient

Two 90 day periods

Thereafter, 60 day periods

Limited health services provided

Keep patients in “flop house”

Low overhead

Maximize Income

Open or buy a hospice

Conspiring or complacent Dr. as Medical

Director

Marketers

Medical Records

Billers

Submit claims

If government starts investigating, move

patients out of county, new “flop house,”

and new business.

Independent Contractor’s who are paid per

patient (14107.2 HS, 550 PC, 750 IC)

Hospice $500.00-$800.00

Per month for 3 months

Home Health $500.00-$800.00

One time or %

Secure hands outcome

Elder Abuse

Allegations

Two caretakers/on-site “medical staff” Each arrested for 5 counts of 368(b)(1) PC- Elder

Abuse

Plead Guilty to one count and sentenced to 1 year in jail.

Both caregivers were on a “Travel Visa” and not authorized to work. With their 2 children in the house.

Middle Manager (RCFE Administrator Certification) arrested for 6 counts of 368(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 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 that the RN’s knew patients were in deplorable conditions.

Joel Ombao, NP, Owner

Beverly Guerrero, RN Ronnel Tiburcio,

Marketer/ManagerNimfa Molina, RN

Gilbert Calma, CaregiverCeleste Calma, Caregiver

Kickback/Bribery

Allegations

Co-Owner (Registered Nurse) authorizing and

paying kickbacks

Arrested and Charged with 750(A) IC, 14107.2(B)

WI- Variations of paying kickbacks

Case pending

5 Managers (Registered Nurses) authorizing,

facilitating, and paying kickbacks

Arrested and Charged with 750(A) IC, 14107.2(B)

WI- Variations of paying kickbacks

Case pending

13 Marketers received cash for recruiting

patients.

Arrested and Charged with 750(A) IC, 14107.2(A)

WI- Variations of Receiving kickbacks

Cases pending

Gina Castromayor

RN, Owner

Alicia Marfori

Ronnel Tiburcio,

Marketer/Manager

Brigita DeJesus

Marianne

Legaspi

JCelso

Ombao

Joelson

Ombao JVoltaire

Ombao

Juliet Meer Cynthia Castillo Belinda Catatocan Liset Garcia

Camille Ombao Billy BombardaPercy Gieseke Mercedes Gosioco Jocelyn ChavezGrace Tabaras

Assurance Hospice

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

San Bernardino 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 in

Charges against 301 Individuals for

Approximately $900 Million in False Billing” US DOJ,

June 22, 2016

“In the Central District of California, 22

defendants were charged for their roles in

schemes to defraud Medicare of approximately

$162 million. In one case, a doctor was charged

with causing almost $12 million in losses to

Medicare through his own fraudulent billing,

including performing medically unnecessary vein

ablation procedures on Medicare beneficiaries.” US DOJ, June 22, 2016

Placing patients in hospice fraudulently

Home health companies fraudulent charges

Inappropriate level of care for patients

Licensing doesn’t match the level of care

provided

Use of unlicensed facilities for patient

“storage”

Abuse of sales and distribution of medical

supplies

$17.5 Billion in Medicaid fraud nationally

Fraud against the Medicare and Medi-Cal

programs

Fraud against individual patients

Neglect against the elderly or dependent

adults

Death

Great Bodily Injury

Illnesses

Current Penal Code 368

(a) definition

(b) under circumstances or conditions likely to

produce great bodily harm. [Felony]

(c) under circumstances or conditions other than

those likely to produce great bodily harm.

[Misdemeanor] *

(d) not a caretaker committing fraud against an

elder [Wobbler]

(e) caretaker committing fraud against an elder

[Wobbler] *

or unlicensed community care facility

While owning, managing, or operating

[Felony]

Penal Code 368

(c) under circumstances or conditions other than those likely to produce great bodily harm. [Misdemeanor] (2) Against residents of an unlicensed residential care facility

Penal code 368

(e) caretaker or person who has a business relationship

committing fraud against an elder [Wobbler]

If the elder or dependent adult is transported from

one residential location to another in furtherance of

the fraud.

[Felony]

Detective Christian Vaughan Riverside Police Department

Family Justice Center3900 Orange AveRiverside, CA(951) 955-5233Cvaughan@riversideca.gov

Special Agent Craig Eastep California Department of Justice

1455 Frazee RdSte 315San Diego, CA 92108(619) 688-6842Craig.Eastep@doj.ca.gov

Questions regarding this

conference please contact:

Steven Brown

Project Coordinator

RUHS

Steven.Brown@ruhealth.org

951-486-5623