STATE OF NEW YORK — COUNTY OF MONROE, TOWN COURT TOWN OF BRIGHTON THE PEOPLE OF THE STATE OF NEW YORK. FELONY ws COMPLAINT TERA POLES, Defendant. Town of Brighton County of Monroe) ss.: State of New York) David Giudici being duly sworn deposes and states: [am an Investigator in the Office of the Attorney General’s Medicaid Fraud Control Unit (“MFCU") in Rochester, New York and I herein accuse the defendant, TERA POLES, of committing the following crimes: Grand Larceny 4" Degree - PL §155.30(1) ~ One Count Offering a False Instrument for Filing 1" Degree ~ PL §175.35(1) ~ Eight Counts as detailed below. Count 1: Grand Larceny in the 4" Degree, in violation of New York State Penal Law §155.30(1), a Class E felony, in that the defendant stole property the value of which exceeded $1,000.00, to wit: Between October 10, 2014 and November 10, 2014, in the town of Brighton, New York, the defendant caused numerous claims to be submitted to the Medicaid program within which she falsely indicated that she had provided hours of private duty nursing services to ALR. that she did not provide, and thereby obtained approximately $1,355.07 to which she was not entitled. Counts 2-9: Offering a False Instrument for Filing 1" Degree, in violation of New York State Penal Law §175.35(1), a Class E felony, in that the defendant, knowing that a written instrument contained false information, and with intent to defraud the state or any political subdivision, public authority or public benefit corporation of the state, offered or presented said written instrument to be filed with, registered, or recorded in or otherwise become a part of the records of such public office, public servant, public authority or public benefit corporation, to wits.Count 2: On or about October 10, 2014, in the town of Brighton, New York, Knowing that a Medicaid claim contained false information regarding 7 hours of private duty nursing hours she purportedly provided to A.R. and with the intent to defraud the Medicaid program, the defendant knowingly caused said Medicaid claim to be filed with the fiscal agent for the New York State Medicaid program, a public office. Count 3: On or about October 13, 2014, in the town of Brighton, New York, knowing that a Medicaid claim contained false information regarding 3 hours of private duty nursing hours she purportedly provided to A.R. and with the intent to defraud the Medicaid program, the defendant knowingly caused said Medicaid claim to be filed with the fiscal agent for the New York State Medicaid program, a public office. Count 4: On or about October 20, 2014, in the town of Brighton, New York, knowing that a Medicaid claim contained false information regarding 5 hours of private duty nursing hours she purportedly provided to A.R., and with the intent to defraud the Medicaid program, the defendant knowingly caused said Medicaid claim to be filed with the fiscal agent for the New York State Medicaid program, a public office. Count §: On or about October 24, 2014, in the town of Brighton, New York, ‘knowing that a Medicaid claim contained false information regarding 7 hours of private duty nursing hours she purportedly provided to AR., and with the intent to defraud the Medicaid program, the defendant knowingly caused said Medicaid claim to be filed with the fiscal agent for the New York State Medicaid program, a public office, Count 6; On or about October 29, 2014, in the town of Brighton, ‘New York, knowing that a Medicaid claim contained false information regarding 1 hour of private duty nursing hours she purportedly provided to A.R., and with the intent to defraud the Medicaid program, the defendant knowingly caused said Medicaid claim to be filed with the fiscal agent for the New York State Medicaid program, a public office. Count 7; On or about October 31, 2014, in the town of Brighton, New York, Knowing that a Medicaid claim contained false information regarding 7 hours of private duty nursing hours she purportedly provided to A.R., and with the intent to defraud the Medicaid program, the defendant knowingly caused said Medicaid claim to be filed with the fiscal agent for the New York State Medicaid program, a public office.unt 8: On or about November 5, 2014, in the town of Brighton, New York, knowing that a Medicaid claim contained false information regarding & hours of private duty nursing hours she purportedly provided to A.R., and with the intent to defraud the Medicaid program, the defendant knowingly caused said Medicaid claim to be filed with the fiscal agent for the New York State Medicaid program, a public office. Count 9: On or about November 10, 2014, in the town of Brighton, New York, knowing that a Medicaid claim contained false information regarding 8 hours of private duty nursing hours she purportedly provided to A.R., and with the intent to defraud the Medicaid program, the defendant knowingly caused said Medicaid claim to be filed with the fiscal agent for the New York State Medicaid program, a public office. I base these allegations upon information and belief, the sources of which are: review of the records of the Office of the Medicaid Inspector General, interviews of individuals known to the Attorney General’s Office, review of various financial and cellular telephone records, and statements of the defendant made to deponent on March 12, 2015 and July 10, 2015, FALSE STATEMENTS MADE HEREIN ARE PUNISHABLE AS A CLASS “A” MISDEMEANOR PURSUANT TO §210.45 OF THE PENAL LAW. Dated: August 26, 2015 bb Investigator New York State Attorney General’s Office