Medicaid Fraud

February 11, 2015:

I received a notice from CareStar, Inc. that my mother’s PCA hours were being “terminated.” I knew that this was an unlawful termination, so I appealed this determination made by CareStar, Inc. employees.  CLICK HERE

June 15, 2015:

In Administrative Appeal Decision 2089120, the ODM’s Administrative Appeal Officer confirmed that the CareStar, Inc. determination was incorrect. The officer wrote, “We therefore ORDER that the hearing decision is REVERSED and COMPLIANCE issued to CareStar, Inc. to rescind the proposed PCA reduction and continue the appellant’s personal care aide services.” This decision also confirmed that the termination of my PCA hours was strictly a CareStar, Inc. determination, and was not initiated by the ODM.  CLICK HERE

June 30, 2015:

I sent another email message to my CareStar, Inc. case manager, and her supervisor, asking if they would finally reauthorize back pay for my mother now that their mistake was overruled by the ODM Administrative Appeal. The supervisor replied with a defiant “NO” – typewritten in all caps – and claimed that they followed all “ODM rules.” The supervisor did not mention that the ODM disagreed with her self-assessment.  CLICK HERE

July 13, 2015:

Thomas J. Gruber – the president of CareStar, Inc. – left a telephone message on our answering machine threatening me if I continued to contact his employees. This forced us to take him and CareStar, Inc. to small claims court.  CLICK HERE

July 27, 2015:

James Lee Keck – a Program Administrator for the ODM – sent an email confirming that CareStar, Inc. is not a state agency.  CLICK HERE

September 9, 2015:

CareStar, Inc. was found liable by the Franklin County Municipal Court (2015 CVI 024968) for my mother’s back pay that was withheld between the State Hearing and the Administrative Appeal.  (This set a precedent for other similar cases.)  CLICK HERE

September 21, 2015:

My mother sent an email asking Michael A. Marrero – Gruber’s lawyer – and Gruber if they were going to pay the court judgment against them, and if Gruber was going to threaten us again.  CLICK HERE

September 22, 2015; 9:29 a.m.:

Marrero said they would not pay, and he and Gruber were “discussing the matter with the ODM.” He also claimed that Gruber did not leave any threatening messages; not knowing that Gruber’s threatening message was saved as evidence.  CLICK HERE

September 22, 2015; 4:05 p.m.:

CareSource – my new case management agency – alerted me to changes made on my All Services Plan. When I checked the plan, it showed where Marrero and Gruber were successful at having Medicaid pay for the court judgment against them by reauthorizing taxpayer dollars.  CLICK HERE & CLICK HERE

September 23, 2015:

Melissa Gualtieri – a clinical manager from CareSource – confirmed that Kris Lintner from the ODM approved Marrero’s tactics. (It is uncertain if she was tricked by Marrero, or if she was complicit.)  CLICK HERE

September 24, 2015; 3:52 p.m.:

Marrero sent an email message to my mother claiming that her employer – Interim Healthcare – was now reauthorized to bill Medicaid for her hours, and hopes this “resolves your claim against CareStar…”  CLICK HERE

September 24, 2015; 7:20 p.m.:

My mother replied to Marrero, Gruber and Medicaid personnel, that she would have no part in their attempt at Medicaid fraud. She alerted them that she would be contacting the Ohio General’s office.  CLICK HERE

September 24, 2015; 7:48 p.m.:

Marrero sent a reply threatening my mother that he would tell the Attorney General that my mother was attempting to collect her back pay twice.  (Apparently, his frustration led him to make this libelous accusation.)  CLICK HERE

September 24, 2015; 8:15 p.m.:

After Marrero threatened to make a false accusation against my mother, I interceded.  CLICK HERE

October 1, 2015:

An admission of guilt arrived on our doorstep. Two money orders totaling the back pay owed to my mother showed up in a UPS envelope. Accompanying the money orders was an unsigned note stating, “CareStar is forwarding two money orders totaling $1293.25 for principle and interest in full and final settlement and satisfaction of the judgment you obtained against CareStar in September 2015 in small claims court and all matters raised in the underlying action.”  CLICK HERE

October 2, 2015; 3:01 p.m.:

I sent an email message to Marrero and Gruber demanding the $78.00 in court costs ordered by the small claims court, along with a “more official and signed document with either Carestar or Ulmer & Berne letterhead.” (Ulmer & Berne is Marrero’s law firm.)  CLICK HERE

October 2, 2015; 3:41 p.m.:

Marrero acquiesced and agreed to send the $78.00, and expressed “wishes to resolve all of the matters,” along with a more conciliatory mention of our proposed call to the Attorney General. It was obvious that he regretted his previous threat – on September 24, 2015 – to lie about my mother to the Attorney General. (He was too late. We had all ready contacted the Attorney General.)  CLICK HERE & CLICK HERE & CLICK HERE

October 8, 2015:

Jordan Finegold – the Assistant Section Chief for the Health Care Fraud Section at the Office of Ohio Attorney General Mike DeWine – replied to my official report documenting the Medicaid fraud committed by Marrero and Gruber. Finegold misunderstood the report, and thought I was accusing someone at the ODM of fraud; someone that his office would need to defend. He stated that R.C. 2913.40(B) requires that a person must “knowingly” commit fraud, so we needn’t worry about being complicit if my mother accepted payment through Medicaid funding. However, I pointed out that 18 U.S. Code § 1347(b) stated otherwise.

October 9, 2015:

I asked Finegold if he agreed with the following statement:

When a Case Management Agency (CMA) – a private subcontractor for the Ohio Department of Medicaid (ODM) – withholds authorization of Medicaid funds from a home healthcare agency and/or their employee(s), and is subsequently ordered by the courts to reimburse the home healthcare agency and/or their employee(s) for this unlawful withholding, the retroactive-reauthorization of these Medicaid funds by CMA and ODM personnel to defray all or part of the aforementioned court judgment – with such retroactive-reauthorization officially and “knowingly” introduced into a Medicaid consumer’s All Services Plan (ASP) – is not to be considered a “fraud matter” by the Ohio Attorney General’s office.

October 13, 2015:

Finegold did not agree with the October 9, 2015 statement, and forwarded my report of Medicaid fraud to Justin Gates in the OAG’s intake department of the Health Care Fraud Section.

Now we will wait and see if CareStar, Inc. is allowed to use taxpayer money to pay a court settlement against a private company – a dangerous precedent.

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