Medicare did have a little rule about "related party" transactions. If, say, a CMHC wanted to do business with a family member, it could — but it would get reimbursed for costs only. It wouldn't be allowed to tack on a profit. Any "related party" relationships must be disclosed.
This technicality did not appear to be an obstacle at Oakland. Bernard Graves and Althea Richards might have lived together since 1990, but they weren't married (until 2001). Yvonne was licensed as a nurse under her maiden name, Yvonne Howell.
In February 1996, the Oakland Community Health Center opened for business on Andrews Avenue (it later moved to Sunrise Boulevard). At the front desk sat a pretty young girl named Mashama Brannigan, fresh out of technical school, where she'd been trained in medical transcription. Althea's high school friend, a woman named Tabatha Harrell, worked as an administrative assistant and also spent much of her time at another business — Basic Home Care Medical Supplies, owned by Althea and her brother Dwight Richards.
On the clinical side of the operation, Oakland hired qualified staff: A stream of licensed clinical social workers (LCSWs) was controlled by the lead therapist, a ponytailed, Ivy League-educated redhead named Neil Leder. For a man with a magic signature who could admit patients and sign prescriptions, Oakland contracted with a friendly psychiatrist: Dr. Zimmer. Yvonne Howell oversaw the day-to-day operations of the clinical team.
According to testimony that was later presented at trial, patients were carted in from Yvonne's nursing homes as well as from other assisted living facilities (or ALFs). For the ALF owners, it was a dream situation: Patients — as few as eight or as many as 40, depending upon the year and season — would be scooped up in the morning and brought to Oakland, where they were fed hot meals and received treatment that included counseling sessions, HIV education, and anger-management classes. They would be dropped back home in the afternoon. This would cost the ALFs not a dime — Medicare picked up the bill.
Intake forms signed by Yvonne Howell show that many of Oakland's patients survived each month on a single Social Security check. An average patient's total income: $650. Expenses: $600 for the nursing home and $50 for medicine. Patients suffered from a variety of mental ills: schizophrenia, bipolar disorder, depression.
Zimmer made a living as something of a freelance doctor, working part-time at several CMHCs. He would drop by Oakland, he says, for about two hours twice a week. For this, Brannigan would later tell the FBI, he was paid $2,000 a week. Upon his arrival, he'd pop in through a back door and check in with Yvonne. "Patients would have already been triaged by a licensed clinical social worker or Yvonne, who was a psychiatric nurse," Zimmer says. "If they met the criteria for admission, they would be met by me." He would see patients and dictate notes on tape. Part of his job, he says, was to move paperwork. He'd sign things such as progress notes and psychological evaluations. In one instance, he left a stack of completed papers with a note dashed on a prescription pad: "I'm caught up! Love, Evan." If asked to, he admits, he would sign blank forms.
For the most part, this arrangement worked fine — except that in order to get money from Medicare, patient files needed to be a certain way. What if Zimmer's diagnosis didn't match what Medicare paid?
Brannigan, who spoke repeatedly to the FBI, said that in the early days, she would type Zimmer's notes precisely — but when Yvonne noticed something that might block Medicare payments, she'd instruct Brannigan to redo the paperwork, adding or omitting key points. For example, Brannigan said, if Zimmer dictated that a patient had "severe dementia," Howell would instruct Brannigan to change it to "mild" or else simply delete it.
Sherri Issa, a social worker who worked at Oakland, told investigators a similar story. If a patient came in clean and tidy, she said, therapists were instructed to note that he showed up disheveled but became tidy by the end of his time at Oakland. Other therapists told similar tales: If someone had dementia, they were to note "altered thoughts" instead. Eventually, the staff knew what was expected.
If Zimmer was not around when bills needed to go out, Harrell later testified, she would simply forge his signature. If a therapist quit before signing her group notes, one of the office staff would cut out her signature from old paperwork and photocopy it onto a new document. What was the difference?