State v. Mahone

2014 Ohio 1251
CourtOhio Court of Appeals
DecidedMarch 27, 2014
Docket12AP-545
StatusPublished
Cited by66 cases

This text of 2014 Ohio 1251 (State v. Mahone) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State v. Mahone, 2014 Ohio 1251 (Ohio Ct. App. 2014).

Opinion

[Cite as State v. Mahone, 2014-Ohio-1251.]

IN THE COURT OF APPEALS OF OHIO

TENTH APPELLATE DISTRICT

State of Ohio, :

Plaintiff-Appellee, : No. 12AP-545 (C.P.C. No. 11CR-08-4337) v. : (REGULAR CALENDAR) Alicia K. Mahone, :

Defendant-Appellant. :

D E C I S I O N

Rendered on March 27, 2014

Michael DeWine, Attorney General, and Daniel H. Huston, for appellee.

Yeura R. Venters, Public Defender, and Emily L. Huddleston, for appellant.

APPEAL from the Franklin County Court of Common Pleas.

BROWN, J. {¶ 1} This is an appeal by defendant-appellant, Alicia K. Mahone, from a judgment of conviction and sentence entered by the Franklin County Court of Common Pleas following a jury trial in which the jury returned verdicts finding her guilty of grand theft, theft, and falsification in a theft offense. {¶ 2} On August 16, 2011, appellant was indicted on one count of grand theft, in violation of R.C. 2913.02(A)(3), one count of theft, in violation of R.C. 2913.02(A)(3), and two counts of falsification in a theft offense, in violation of R.C. 2921.13(A)(9). The indictment arose out of an investigation by the Health Care Fraud Section of the Office of No. 12AP-545 2

the Ohio Attorney General into the billing practices of appellant, a home health aide, for reimbursement claims submitted for services to Medicaid recipients. {¶ 3} The matter came for trial before a jury beginning March 5, 2012. The first witness to testify on behalf of plaintiff-appellee, the state of Ohio, was Rosemary Walton, employed by the Ohio Department of Job and Family Services ("ODJFS") as a compliance manager for the Ohio Home Care Program ("OHC"). Under the OHC waiver program, Medicaid eligible individuals with "high level" needs (and who might otherwise risk placement in a nursing home or hospital) receive home care services. (Tr. Vol. I, 85.) {¶ 4} Qualified providers of home health services include agency and non-agency providers. Non-agency providers are also known as "independent providers." (Tr. Vol. I, 86.) A "personal care" or "home health" aide is one type of non-agency provider. (Tr. Vol. I, 87.) Home health aides perform services for clients such as bathing, dressing, grooming, laundry, and cleaning. Independent providers utilize an "All Services Plan" that documents goals and objectives based on the assessed needs of the client. (Tr. Vol. I, 89.) {¶ 5} Medicaid pays only for services actually rendered. In order to receive reimbursement, an independent provider is required to maintain clinical records, i.e., written documentation that includes the services provided, as well as arrival and departure times. The billing system for Medicaid reimbursement utilizes billing codes and providers submit claims for payment based on 15-minute units. {¶ 6} Individuals seeking to become Medicaid service providers submit to an application process; upon meeting eligibility, ODJFS assigns to a provider a seven-digit provider number for billing purposes. At trial, Edward Zachrich, supervisor of the Provider Enrollment Unit at ODJFS, identified appellant's application and provider agreement. {¶ 7} A provider has the option of either billing directly to the state or utilizing a third-party billing service. Appellant's billing was handled by a third-party service, Dyserv, a Columbus based medical billing company that has a provider agreement with ODJFS. Dyserv processed Medicaid claims from information provided by appellant, which it then transmitted to ODJFS. No. 12AP-545 3

{¶ 8} ODJFS processes Medicaid claims for the state. During the period from 2007 to 2011, ODJFS utilized the "Medicaid Management Information System" for processing the payment of Medicaid claims. (Tr. Vol. I, 148.) Deonne Clark, an administrative officer with ODJFS, testified that the term "fee for service" describes "a price that is given to a procedure" with respect to a patient; reimbursement occurs after a provider submits a fee claim. (Tr. Vol. I, 149.) During 2010 and 2011, appellant received payment under the fee for services system as an independent provider. {¶ 9} ODJFS relies on the provider for submission of claims. Payments made to a particular provider appear on a remittance advice report, which summarizes all claims submitted by the provider during the previous week. A remittance advice contains information that includes the provider's name, address, and provider number, the recipient of services, the procedure code, the amount billed, the amount allowed for payment, and the amount paid to the provider. ODJFS issues remittance advice to providers on a weekly basis. At trial, the state offered as exhibits various remittance advice reports for services by appellant involving Medicaid recipients Samuel, Marion Hart, James Eiben, and Pamela Kasunic. Clark, a custodian of those records, identified appellant's seven-digit provider number and also identified the billing number for Medicaid recipient Samuel. {¶ 10} Thomas Holsinger, an employee of the Office of Budget and Management ("OBM"), testified that one of the duties of OBM is to pay claims submitted to the state for services rendered by providers. OBM maintains electronic records of payments, and Medicaid providers are paid through the use of an electronic fund transfer ("EFT"). At trial, Holsinger identified state's exhibit D as a direct deposit EFT form for Medicaid payments to appellant. {¶ 11} Joseph C. Pledger is retired and the brother of Samuel. Samuel passed away on January 4, 2012 at the age of 63. Prior to his death, Samuel resided in an apartment building, the Notre Dame Apartments located at 1325 Angel Road, Cleveland. He moved into the apartments in September 2009, and his one-bedroom apartment was located on the third floor of the building. In 2010, Samuel was taking medication for diabetes. Prior to moving into the apartment building, he received assistance with cooking and errands from a home health aide, Brenda Campbell. No. 12AP-545 4

{¶ 12} The apartment complex has a security desk and visitors are required to sign in and out. When visiting his brother, Joseph would indicate on the sign-in sheet the apartment number. Joseph testified that a security officer was there "most times unless they had to go away for a round or some other business." (Tr. Vol. II, 58.) {¶ 13} Joseph was not familiar with appellant and testified that he "never met her." (Tr. Vol. II, 56.) In December 2010, after his brother was admitted to the hospital, Joseph received a call from "a young lady," indicating she was Samuel's aide. The woman stated she was "looking for a black book." (Tr. Vol. II, 56.) Joseph returned the call and told the woman he "didn't see a black book." (Tr. Vol. II, 56.) The woman told him "they had found it." (Tr. Vol. II, 56.) At trial, Joseph testified he did not remember ever seeing appellant at his brother's apartment. {¶ 14} Sherina Pledger, age 21, is a nursing assistant and the niece of Samuel. Sherina is also a student at Lorraine Community College. While on break from college, Sherina occasionally would stay with her uncle at the Notre Dame Apartments. Upon entering the apartment complex, she would sign in and then "go to the * * * number keypad and you get buzzed." (Tr. Vol. II, 81.) Sherina would sign her name, noting the time and apartment number she was visiting; she was also required to sign out. {¶ 15} Sherina did not recall any home health aides assisting her uncle during the period of April through December 2010. Prior to that time, Sherina recalled a home health aide named Brenda Campbell who assisted her uncle, including during the time he resided at the Notre Dame Apartments. Sherina was not familiar with appellant. Samuel once told her "he was getting an aide," but that was the only time they had such a discussion. (Tr. Vol.

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Cite This Page — Counsel Stack

Bluebook (online)
2014 Ohio 1251, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-v-mahone-ohioctapp-2014.