NewsNewsChannel 5 Investigates


Hidden Camera Reveals Medicare Fraud

Posted at 1:06 PM, Mar 11, 2014
and last updated 2015-09-07 14:47:09-04

By Ben Hall
Investigative Reporter

They charge taxpayers millions of dollars for counseling Medicare recipients.

But a NewsChannel5 investigation has discovered numerous cases in which the counseling never happened.

Psychotherapy fraud is the number one type of Medicare fraud in Tennessee.

It happens when doctors or social workers bill Medicare for counseling elderly patients, but the counseling is either never done or performed by unlicensed caregivers.

NewsChannel5 Investigates obtained undercover video showing a social worker inside a Humphreys County nursing home.

Janet Renee Vaughn claimed she spent 20-30 minutes with patients and billed Medicare tens of thousands of dollars.

But the video proves she spent less than five minutes with many residents and fabricated reports turned into Medicare.

"It's Medicare fraud plain and simple and it's stealing from taxpayers," said Special Agent Richard Haines, who is an investigator with Health and Human Services Office of Inspector General.

Agents caught Vaughn after hiding a camera in an alarm clock then watching how long she interacted with patients.

Vaughn pleaded guilty to health care fraud and must re-pay the government more than $85,000.

Psychotherapy fraud is becoming more and more common.

In fact, there have been a flurry cases in middle Tennessee responsible for taking millions of dollars from cash the strapped Medicare and TennCare programs.

Glenesha Moye and Tabitha Jones pled guilty to defrauding Medicare of more than a million dollars.

Their Nashville based health care company billed Medicare for psychotherapy services that either never happened or was done by unlicensed people.

Then there's the case of Nashville doctor Cupid Poe.

He pleaded guilty to fraud that involved sending untrained people like former patient, Delano Avent, into nursing homes to council residents.

NewsChannel5 Investigates asked Delano Avent, "What kind of training do you have?"

Delano Avent responded, "I have training with my family."

Dr. Poe billed taxpayers for counseling done by Avent, who was not licensed.

"I would asked them how they are doing," Avent said. "How do you feel? Did you like your lunch? Did you like your dinner?"

NewsChannel5 Investigates discovered Poe's case was connected to another fraud case involving Candyce Jones, who ran a Nashville based healthcare company called Merilee Healthcare.

"This kind of fraud really has a crippling effect on our Medicare programs," said U.S. Attorney for Middle Tennessee, Jerry E. Martin.

Martin is making Medicare fraud one of his top priorities.

Court documents show Poe actually gave information that helped prosecute Candyce Jones.

Prosecutors said her company billed Medicare for psychotherapy that either never happened or was performed by untrained people.

"This case involved a $650,000 loss to the Medicare program, and that's a lot of money," Martin said.

But the Jones case is even more unusual because Jones is married to a man who used to have Martin's job.

Quenton White was the U.S. Attorney in middle Tennessee in 2000 and 2001.

Jones and White got married last year, and he was by Jones side in court when a judge sentenced Jones to three years in prison.

More than a thousand doctors and social workers bill Medicare for counseling each year in Tennessee

The message from the US Attorney is they're watching more closely than ever.

The Department of Health and Human Services has set up a confidential hotline to take calls from people who believe they have seen Medicare fraud.

The number is 1-800-447-8477.


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