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44
NOV / DEC 2013
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Healthcare Journal of NEW ORLEANS
felony charges, including racketeering, criminal
conspiracies to commit Medicaid fraud and filing
false public records, Medicaid fraud, filing false
public records, theft by fraud, forgery andmoney
laundering in connection with a scheme to bill
Louisiana’s Medicaid program for services not
actually rendered.
Investigators with the Attorney General’s Med-
icaid Fraud Control Unit, assisted by the St. Tam-
many Parish Sheriff’s Office, arrested Donna Sue
Davis; her husband, Randall Duane Davis; and her
niece, Rachel Wedekind; all of 14665 Graci Road in
Folsom. They are accused of jointly engaging in
a criminal conspiracy to present false claims for
payment to the state’s Medicaid program for ser-
vices that were not rendered as billed. After their
arrests, the triowas booked into the St. Tammany
Parish Correctional Center.
The criminal charges allegedly stemfroma crim-
inal enterprise establishing a network of direct
serviceworkers from immediate familymembers
who were paid wages to care for a disabled rela-
tive 24 hours per day, seven days per week. This
criminal activity allegedly occurred between Jan-
uary 1, 2009, and August 21, 2013, and was billed
through the Medicaid provider, My Purpose Com-
munity Service, Inc. located at 1377 West Gause
Boulevard, Slidell.
Investigatorswere also advised that the trio had
allegedly committed cruelty to the infirmed by
the intentional and criminally negligentmistreat-
ment of the disabled relative—a completely bed-
ridden, adult paraplegic suffering from cerebral
palsy—by leaving the relative unattended in the
evening hours and by exposing him to personal
injuries caused by two Capuchinmonkeys. Donna
Davis, and her husband, Randall, are also accused
of using the disabled relative’s Social Security dis-
ability benefits and wages paid to the relative’s
caretakers for their own personal gain.
Long-Term Supports and
Services Changes Outlined
The Department of Health and Hospitals has
releaseda concept paper outlining the initial steps
in a process to better manage long-termsupports
and services for thousands of Louisiana residents.
The document, titled “Transforming Louisiana’s
Long Term Care Supports and Services System,”
provides the initial framework for adiscussionwith
consumers, communitymembers, advocates, and
the public about the best path forward for imple-
menting managed long-term supports and ser-
vices (MLTSS) in Louisiana. The goals of the pro-
gramoutlined in the concept paper are to improve
thequality and coordinationof care, utilizeproven
practices, expand service choices for patients and
families, and improve the financial stability of pro-
grams aimedat serving individuals inneedof long-
term supports and services in their communities.
The framework outlined in the concept paper
considers inclusion of three key populations
receiving long-term supports and services—frail
elderly, individuals with adult-onset disabilities,
and individuals with developmental disabilities.
Final decisions about programdesignwill bemade
in linewithguidance fromtheCenters forMedicare
and Medicaid Services and in conjunction with
significant stakeholder input. The concept paper
outlines areas where the Department is seeking
guidance, including options on benefit design,
populations to be included, coordination of care,
consumer protection, provider requirements,
desired outcomes and quality measures, choos-
ing effectivepartners andensuring accountability.
The transformation process will be guided by
an advisory group comprised of stakeholders
based on the recommendations from the Cen-
ters for Medicare and Medicaid Services. That
advisory group will include representation from
advocacy, consumer, policy, government and pro-
vider groups.
Public engagement and input will be a criti-
cal component of the transformation outlined
in the concept paper. DHH plans to hold public
forums throughout the state to solicit meaning-
ful dialogue, to answer questions and accept
public comments. The advisory group will also
meet regularly to advise the Department through
its design and implementation of the MLTSS
program. Throughout the process, information
(including a schedule of meetings and forums)
will be posted on MakingMedicaidBetter.com.
Comments, questions and feedback may also
be submitted by email to LongTermCare@la.gov.
Visit MakingMedicaidBetter.com/LongTermCare to
download a copy of the concept paper.
Clinic and Operator
Sentenced for Fraud
California citizen Siranush Tulumdzhyan, age 28,
has been sentenced by U.S. District Court Judge
Eldon Fallon for her role in a healthcare fraud
scheme in Louisiana. Tulumdzhyan was sen-
tenced to 3 years probation with 6 months in a
half-way house and ordered to pay restitution to
Medicaid in the total amount of $31,589.
LA Medical Group, Inc., a Louisiana corporation
that she operated as a medical clinic, was also
sentenced to three 3 years supervised release. LA
Medical Group, Inc. was ordered to pay restitu-
tion to Medicaid in the total amount of $494,268.
The Government seized $269,057 from the
corporation.
According to the bill of information, the defen-
dants participated in a criminal organization for
the purpose of fraudulently billing Medicaid.
Patients went to the medical clinic for medical
tests that were not performed or medically nec-
essary. Patients were moved between Metairie
Health Care to LA Medical to repeatedly perform
the same unnecessary tests. Metairie Health Care
has already been sentenced for the same activ-
ity. According to the bill of information, if the
patients refused the diagnostic tests at LA Medi-
cal, prescriptions for narcotic drugs were with-
held. Thereafter, bills for the unnecessary services
were submitted to Medicaid. Tulumdzhyan was
the owner of LA Medical and also an unlicensed
and unqualified diagnostic technician, according
to the bill of information.
Gulf South Quality
Network Joins QBPC
Gulf South Quality Network, the largest clinically
integrated physician network in Louisiana, com-
prising more than 1,600 physicians representing
East Jefferson General Hospital, West Jefferson
Medical Center, Slidell Memorial Hospital, Tulane
University Medical Center, Tulane/Lakeside Hos-
pital, and Lakeview Regional Medical Center, has
joined Blue Cross and Blue Shield of Louisiana’s
innovative Quality Blue Primary Care (QBPC)
program. QBPC is a population health and qual-
ity improvement program designed to get better