Two Mass. women arrested in $100 million home health care scam, federal prosecutors say

By Travis Andersen

Two Massachusetts women were arrested Sunday on federal charges alleging their involvement in a $100 million home health care fraud scheme in which vulnerable patients were used in a plot to bill for services that were never performed, among other criminal actions, prosecutors said Monday.

In a statement, US Attorney Andrew E. Lelling’s office identified the defendants as Faith Newton, 52, of Westford, and Winnie Waruru, 41, of Lowell, and said the alleged scheme allowed Newton to purchase items including a Maserati and several homes, which the government is moving to seize in a separate civil action.

Raymond Sayeg, an attorney for Newton, said via e-mail that his client “denies the allegations contained in the Indictment and she intends to vigorously defend herself in this action.” A lawyer for Waruru declined to comment.

Both women were indicted on one count of conspiracy to commit health care fraud; one count of health care fraud — aiding and abetting; and one count of conspiracy to pay and receive kickbacks. Newton was also indicted on one count of money laundering conspiracy and seven counts of money laundering, the statement said.

In addition, Lelling’s office said, Waruru was indicted on two counts of making false statements and one count of making a false statement in a health care matter. Both women were slated to make their initial appearances in federal court in Boston on Monday afternoon.

Details on the hearing weren’t immediately available.

Lelling’s office said the indictment alleges that from January 2013 to January 2017, Newton was part owner and operator of Arbor Homecare Services LLC, and Waruru was a licensed practical nurse, or LPN, employed by the company as a home health nurse.

Newton and Waruru, the statement said, allegedly plotted to use Arbor to defraud MassHealth and Medicare of at least $100 million by committing health care fraud and paying kickbacks to get patient referrals. Newton then allegedly laundered the illicit funds, according to the statement.

Prosecutors allege that Arbor, through Newton and others, failed to train staff; billed for services that were never provided, or that weren’t medically necessary; and billed for services that weren’t authorized.

Arbor, Lelling’s office said, through Newton and others, allegedly developed employment relationships as a way to pay kickbacks for patient referrals. They also allegedly entered sham employment relationships with patients’ relatives to provide home health aide services that weren’t medically necessary and routinely billed for fraudulent visits that Newton knew didn’t occur, according to the statement.

As alleged in the related civil complaint, the statement said, Newton, either directly or through Arbor, targeted vulnerable patients who were low-income, on disability, or suffering from depression or addiction.

Waruru and Arbor, the statement said, allegedly billed MassHealth for skilled nursing visits that she didn’t actually perform. Waruru also allegedly passed cash payments from Newton to an Arbor patient to retain that patient, according to prosecutors.

Newton allegedly used the laundered proceeds of “the $100 million scheme” to buy multiple homes and a luxury Maserati vehicle and to fund investment accounts, “a lavish lifestyle, and numerous financial transactions,” the statement said.

A related civil forfeiture case brought by the government seeks to compel Newton to forfeit to federal authorities five properties in Westford, North Andover, Chelmsford, and Dracut and to give up the contents of 40 bank accounts or investments, the statement said.

Both women face a possible prison term if convicted in connection with the case.

“The charges of health care fraud, conspiracy to commit health care fraud, money laundering conspiracy, and money laundering each provide for a sentence of up to 10 years in prison, three years of supervised release, and a fine of up to $250,000 or twice the amount of the money involved in the laundering,” the statement said. “The conspiracy to pay kickbacks, make false statements, and make false statements in health care matters each provide for a sentence of up to five years in prison, three years of supervised release, and a fine of up to $250,000.”

Sentences, Lelling’s office added, are imposed by a judge based on US sentencing guidelines and other statutory factors.

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Two Mass. women arrested in $100 million home health care scam, federal prosecutors say

AdventHealth Orlando seeks dismissal of lawsuit from family of man whose death sparked state’s guardianship scandal

Steven Stryker, seen here during his time working for the Environmental Protection Agency, according to his daughter. Stryker died while under the care of Rebecca Fierle, who according to investigators filed a "do not resuscitate order against Stryker's wishes.(Courtesy of Kim Stryker)

By Monivette Cordeiro

AdventHealth Orlando asked a judge Tuesday to dismiss a negligence lawsuit filed against the hospital company and former guardian Rebecca Fierle by the family of an incapacitated client who died under a “do not resuscitate” order that Fierle signed against his wishes.

The Altamonte Springs-based company said there are “no allegations” that it played a role in Fierle’s decision to authorize a DNR order on 75-year-old Steven Stryker or that it exercised control over his care after he was discharged from the hospital.

Stryker’s death last May at St. Joseph’s Hospital in Tampa sparked a statewide scandal that led to reforms of Florida’s troubled guardianship system and landed Fierle behind bars on charges of aggravated abuse and neglect of an elderly person.

“The complaint contains no ultimate facts establishing AdventHealth’s liability for any of the alleged events after Steven Stryker’s discharge from AdventHealth Orlando,” wrote J. Charles Ingram, the hospital’s attorney, in an April 21 motion.

Stryker was a patient at AdventHealth Orlando in 2018 when the hospital petitioned a judge to declare him incapacitated and appoint Fierle to be his guardian. Although Stryker had made his friend Linda Lanier his health-care surrogate, an attorney for the hospital said he wasn’t capable of choosing his decision-maker.

Lanier has told the Orlando Sentinel that AdventHealth seemed determined to put Stryker into guardianship and get him discharged from the hospital, despite her efforts to find him a new place to live.

Without the required court approval, Fierle billed AdventHealth nearly $4 million over a decade for providing services to Stryker and nearly 700 other vulnerable patients, according to an audit by the office of Orange County Comptroller Phil Diamond.

“Rebecca Fierle’s negligence, neglect, abuse, and exploitation of Steven Stryker caused his death,” said the lawsuit filed by Kimberly Stryker, the man’s daughter who is in charge of his estate. “AdventHealth created, facilitated, and funded the guardianship relationship between Rebecca Fierle and Steven Stryker and is therefore responsible for the actions that led to Mr. Stryker’s death.”

After Stryker became her ward, Fierle disregarded the opinions of his daughter, health care surrogate and a St. Joseph’s psychiatrist in signing the DNR, according to an investigation by the Okaloosa County Clerk of Circuit Court and Comptroller.

Fierle opted to cap Stryker’s feeding tube on May 9, despite him stating “several times that he wanted to live,” the Florida Department of Law Enforcement said. Stryker, who was using a feeding tube because he had difficulty swallowing, aspirated and went into cardiac arrest.

He died May 13.

Ingram said AdventHealth could not predict Fierle would enter a DNR against Stryker’s wishes or that his daughter and St. Joseph’s would not intervene to overturn her decision.

“The events at St. Joseph’s Hospital completely fail to allege anything creating liability on the part of AdventHealth in terms of duty, breach, causation or vicarious liability,” Ingram said. “Instead, these allegations suggest that St. Joseph’s Hospital owed a duty to Mr. Stryker as its patient, that there was a failure to protect Mr. Stryker from his court-appointed guardian, and that St. Joseph’s Hospital felt obligated to follow the instructions of the court-appointed guardian.”

After Stryker’s death, the hospital company announced it would no longer pay private guardians to take on patients and would form a review panel to ensure at least two doctors determine whether patients can no longer make their own decisions before asking a judge to appoint a guardian.

In addition to misusing DNRs and ignoring her wards’ wishes, Fierle, who is still under investigation by multiple agencies, has also been accused of double-billing and conflicts of interest.

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AdventHealth Orlando seeks dismissal of lawsuit from family of man whose death sparked state’s guardianship scandal 

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AdventHealth outlines guardianship changes after paying disgraced guardian nearly $4 million | Exclusive

AdventHealth Orlando CEO Daryl Tol in his office. Thursday, Nov. 21, 2019. Tol revealed changes the hospital is making to its guardianship practices in the wake of the Rebecca Fierle scandal. (Sarah Espedido / Orlando Sentinel)

AdventHealth Orlando will make sweeping changes to how it handles court-appointed guardianships for vulnerable patients after a probe found the hospital paid disgraced guardian Rebecca Fierle nearly $4 million to care for hundreds of its incapacitated patients.

The hospital will no longer pay private guardians to take on cases, will form a review panel to ensure at least two doctors determine whether patients can no longer make their own decisions before asking a judge to appoint a guardian, and will provide more training to care managers, said Daryl Tol, president and CEO for AdventHealth’s Central Florida Division, in an exclusive interview with the Orlando Sentinel.

The changes come after the hospital hired an outside law firm to conduct an audit of its campuses in Orange, Seminole and Osceola counties. Tol said the hospital will also put its political heft behind statewide reforms for the troubled guardianship program, advocating for lawmakers to increase funding, add more oversight for guardians and clarify the legal definition of incapacity.

“We have put too much trust in a flawed system,” Tol said. “And that is not something we want to continue doing or want to do again.”

Tol, who did not provide the Sentinel with a copy of the audit during an interview Thursday, said no wrongdoing was found on the part of hospital staff. He said the Sentinel’s reporting about flaws in the guardianship system served as a “positive catalyst” for some of the changes.

Fierle first came under scrutiny when one of her incapacitated clients, 75-year-old Steven Stryker, died at a Tampa hospital in May after staff were unable to perform life-saving measures because of a “do not resuscitate” order Fierle filed against his wishes and refused to remove, according to state reports. Less than a year before his death, AdventHealth Orlando had petitioned a judge to appoint Fierle as Stryker’s guardian when he was a patient there, despite him having a health-care surrogate.

The embattled guardian later admitted to routinely filing DNRs on her wards.

An audit by the office of Orange County Comptroller Phil Diamond later found Fierle improperly billed AdventHealth close to $3.96 million over a decade for services she provided to 682 of its patients, either as a court-appointed guardian, durable power of attorney, heath care surrogate or proxy. The hospital system paid at least $3.7 million, according to Diamond’s office.

Tol said the hospital spends about $30 million a year on care management for patients, which until now has included payments to guardians along with other costs, such as helping patients transition to group homes or other facilities.

As an example of the how challenging it can be to find long-term care for patients, he said employees once made more than 1,000 phone calls to find a group home for a man who was able to make his own decisions, but couldn’t live alone and didn’t have any money or family. AdventHealth Orlando is now paying for the man to live in a group home in California, he said.

About 70 patients a year are admitted to one of the hospital’s Orlando campuses who end up needing a court-appointed guardian because they can no longer make decisions and do not have family or friends who can do so for them, he said.

“If you call a smaller hospital, it could literally be years in between these situations because of the volume,” Tol said. “Because of the 140,000 admissions a year, it just so happens that a rare thing happens more frequently here.”

Typically, private and public guardians are paid through the ward’s assets or by the state to make all legal, financial and medical decisions for incapacitated people. But the multimillion-dollar arrangement, which is not allowed under Florida law without a judge’s approval, has been described by experts as virtually unheard of in the industry. It is problematic, they say, because the hospital’s wishes could conflict with the best interests of the ward.

“I would say, with regret, that it was a misunderstanding and the payments were made in good faith for the services as deemed appropriate by our care management team,” Tol said.

At times, Fierle submitted identical invoices to the hospital and the court to get paid twice for the same service and net three times the court-approved maximum fee, according to the comptroller’s probe. The probe only reviewed AdventHealth hospitals in Orange, Seminole and Osceola counties but did not look at the company’s other entities, which likely also paid Fierle.

“We were unaware that there was double billing happening, and we were an unwitting victim of that,” Tol said.

Tol said AdventHealth’s relationship with Fierle developed over 20 years. The hospital company used other guardians but primarily relied on Fierle because she was “responsive” and would take cases quickly.

“She would take on cases very easily, was easy to work with from the perspective of the team’s ability to get in touch with her,” he said. “And yet, of course, the team didn’t realize the things that have been brought to light. … Sometimes there are bad actors in the middle of a lot of good people trying to do good work.”

AdventHealth spokesman Bryan Malenius previously told the Sentinel the hospital petitions a judge to appoint a guardian as a “last resort” because it can’t discharge patients unless they have a safe place to go. AdventHealth asks the Florida Department of Children and Families to step in when those situations arise, but the state agency regularly declines, Tol said.

“We have faced over the years a very challenging dynamic in which DCF will reject the responsibility for the situation, and frankly, just leave it in our hands,” he said. “That leaves our team of advocates dealing directly with the courts and with guardians.”

DCF spokeswoman Kristi Gray has previously said guardianship is “not a DCF process.”

“When the agency identifies a need for guardianship on an open case, our attorneys navigate that judicial process,” Gray said in a statement in October.

Tol said AdventHealth has petitioned the courts for professional guardians in order to expedite safe discharges to a “better and healthier location” because the wait for a public guardian to be appointed can be lengthy.

“The hospital is not intended to be a long-term safe residential facility,” Tol said. “If the public guardian is not readily available, it is not in the interest of the individual when they’re not in an acute health care episode to remain in the hospital setting surrounded by other very sick people. They are much better off in the appropriate care setting.”

The hospital CEO and president said AdventHealth believes Florida should clarify and strengthen the responsibility of DCF to care for incapacitated people.

“We think there needs to be an intensive review of cases where DCF has refused to assist patients so that at least it’s understood why that was the case,” Tol said. “... We’re not looking to point fingers or identify bad guys, other than perhaps the guardian in question, but aside from that, we just think it’s got to be a better team effort.”

The AdventHealth Orlando CEO said the hospital is cooperating with law enforcement in criminal investigations into Fierle but the company is not pursuing independent legal action against the former guardian.

“We want to be a partner with all those trying to get to the bottom of it in this specific case,” Tol said.

Fierle, who has resigned as a guardian, is not currently facing any charges.

Full Article & Source:
AdventHealth outlines guardianship changes after paying disgraced guardian nearly $4 million | Exclusive

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Guardian at center of Florida scandal appeals judge’s ruling that she broke state rules by misusing DNRs

By Monivette Cordeiro

Gerald Manczak, a ward of Rebecca Fierle, said this "do not resuscitate" order was filed without his permission by the professional guardian. (Monivette Cordeiro / Orlando Sentinel)

Former Orlando guardian Rebecca Fierle is appealing a judge’s ruling that she violated state rules by misusing “do not resuscitate” orders on incapacitated clients and improperly billing AdventHealth nearly $4 million for services she provided to their vulnerable patients.

An attorney for Fierle, who resigned as a guardian statewide July 25, filed two petitions Monday asking the state’s Fifth District Court of Appeals to reverse the ruling from Orange County Circuit Judge Janet C. Thorpe and remove the judge from the case.

Fierle’s attorney, Harry Hackney, argues Thorpe overstepped her authority by disciplining his client and wrongly suggesting the Orlando guardian needed permission prior to signing DNRs from the judge or wards’ family members.

“She can consult family and friends to discern what the ward would have done when competent,” Hackney argued. “She is NOT required to get their permission nor the court’s.”

The embattled guardian is under criminal investigation after the death of 75-year-old Steven Stryker, a ward who died at a Tampa hospital after staff were unable to perform life-saving measures due to a “do not resuscitate” order Fierle filed against his wishes and refused to remove.

An investigation by the office of Orange County Comptroller Phil Diamond found Fierle charged AdventHealth, a Central Florida hospital company, about $3.96 million over a decade for services to 682 patients — a financial arrangement not allowed under Florida law without court approval.

In a Sept. 12 order, Thorpe said Fierle violated several state administrative rules, including mandates to avoid conflicts of interest when addressing wards’ needs and a ban on soliciting or accepting incentives from service providers.

“Based upon the Comptroller’s Report, this Court has no confidence in Ms. Fierle’s actions, reliability, or truthfulness as a professional guardian,” Thorpe wrote. “This court finds probable cause to permanently remove Rebecca Fierle from any appointment in Orange County as a professional guardian.”

But Fierle’s attorney Harry Hackney in the appeal petitions argued the judge’s order was filed without a hearing and without giving Fierle a chance to contest the findings.

“The proceedings in question were apparently conducted secretly by Judge Thorpe in chambers after receiving multiple hearsay reports,” the petition said. “Those proceedings still must comply with the Rules adopted by the Florida Supreme Court and not with the whim of one judge.”

The Florida Department of Elder Affairs’ Office of Public and Professional Guardians has “exclusive jurisdiction” over the discipline of guardians, not Thorpe, Hackney said.

“Judge Thorpe had no authority to proceed to make findings of fact regarding violations of law by Rebecca Fierle or to take steps to ‘remove’ Rebecca Fierle as Professional Guardian after she had resigned,” according to the appeal.

Hackney also argued Thorpe “misconstrued” the rules surrounding DNR orders. In her order finding probable cause, the judge said Fierle violated her duty to act in the best interest of her incapacitated clients by placing DNR orders on them without bringing the issue before the court.

“No guardian can ‘place’ or execute a ‘Do Not Resuscitate Order’ because it is a medical order that must be entered by a physician,” Hackney said.

If a patient is incapacitated, the DNR order can be signed by the patient’s health-care surrogate, health-care proxy or court-appointed guardian delegated to make medical decisions, he wrote.

Thorpe in her ruling cited a provision in Florida’s Administrative Code governing the withholding of medical treatment. If a ward’s “past or current wishes” conflict with what a guardian feels is best, the guardian “shall have this ethical dilemma submitted to the court for direction,” the rule says.

But Hackney said the rule is only meant to permit a guardian to seek a judge’s guidance “when the course of action is not clear” — not to require it.

“If the Guardian acted under the statute she would be immune from civil or criminal liability for the DNR decision,” the petition said. “There was no legal basis ... to support Judge Thorpe’s ruling that court approval needed to be sought prior to consenting to a DNR Order executed by a physician for the benefit of the Ward.”

In Stryker’s case, an investigation by the Okaloosa County Clerk of Circuit Court and Comptroller found Fierle refused to remove the DNR order despite Stryker’s desire for life-saving actions and against the wishes of his daughter, his health-care surrogate and a psychiatrist.

When asked about the DNR she filed on Stryker, Fierle told Okaloosa Clerk auditor and investigator Andrew Thurman that it was “an issue of quality of life rather than quantity” and Stryker had agreed to it.

“The ward had never previously expressed a desire to die, and it seems unlikely that, as soon as he was appointed a guardian, he would suddenly be unwilling to tolerate a condition that he had been dealing with for many years,” Thurman wrote in his report.

The Ninth Circuit Judicial Court was unable to comment on the appeal, a spokeswoman said.

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Guardian at center of Florida scandal appeals judge’s ruling that she broke state rules by misusing DNRs