COMMONWEALTH OF PENNSYLVANIA POLICE CRIMINAL COMPLAINT COUNTY OF: BRADFORD COMMONWEALTH OF PENN SYLVANIA Magisterial District Number. 42-3-02 = MDJ: Hon. LARRY J. HURLEY DEFENDANT: (NAME and ADDRESS): ‘Address: 75 HERRICK AVENUE _STEPHANIE GWEN KING _ SAYRE, PA 18840 FirstName ‘Midele Namo Last Name ee 6860 SHESHEQUIN ROAD, ULSTER, PA 18850 Telephone: (570)888-6324 aa Rar REESE TPIT WNCIG ENraaiion|Code Type PS TT 2 ht Felony Full 1S Fetony Pending Extradition ‘Ciisdemesnor Surounaig Siales L paance i 2-Fetony Limited Ci e-Fetony Pending Exradtion Deter. C]D-Misdemeanor No Extradition Da-elony Surouncing States C) AMisdemeanor Fut LE-Misdemesnor Pending Extraction D 4-Fetony No Extraction T1B-Miscemeanor Lined TF Wisdemesnor Pending Extradtion SESE TRESS /DEFENDANTIDENTIRCATION INFORMATION k RE Docket Number Date Filed | OTWLiveScan Number Complanuincident Number | Reguest Lab — SS D159 H4/59 RIN NGI-G MEI200036314 ives One GENDER 08 07/07/1976 _|'pos ‘Add DOB, GCo-Defendante) C1 tate First Name Miao Nam Last Nane Gen Ea Fees axa _ STEPHANIE GWEN BIDWELL F ci wae zn : ak ave Aner maaan =] ETHNICITY ieponic ee om wees _ oir SRY —CDReDRewmuony — sor sen = atu@uey) rte unl) 2 bro (ow) Color | C18tx (lack) Coons (orange) wn cvmitey Ch (Unks8ai) C1 GRN (Green) Deni eink) T1ELN iodo Suanbery) Eye aixe@any aw Gey Ta Grew TiarN Green Dew ean Color’ Ch naz etazey Dinar aso EL pn rey Bw ates xxx eirowny DNA C1YES_C1No | DNA Location WEIGHT (Ibe) FI Number MU Numbor Defendant Fingerprinted” | CI YES UNO : FREIGHT In. Fingerprint Classification; | z ‘DEFENDANT VERIGLE INFORNATION = ‘Biaie | Haz Reaistvation ‘Comm’ Veh. | ~Seheai Veh. | OK NCIC Veh Code] Reg Plate # mat | stckor(amryy)—/ tnd. a same o - 8 Dot. vi Year] Wake dat Siyie Ee o Office ofthe attorney for the Commonwealth Cj Approved [i Disapproved because; hs atiomey Tor the Commonwealh may requre Wal ie COMBAT, toring. Soe Pa R Grim P. 507). SDAG MARK BELLAVIA / DAG CHRIS SHERWOOD (Wame o he atomey for the Cmmonwea, 1,_SA MATTHEW G. YOCUM / SA DAV! ‘ame ofthe Affant) Pennsylvania Office of Attorney General ‘(enti Department or Agenoy Represented and Poca Subawaion) do hereby state: (check appropriate box) emetic CHALK, of 1. Bl accuse the above named defendant who lives at the address set forth above I accuse the defendant whose name is unknown to me but who is described as ‘RGaYE_ pr Bot be approved by the Wlarnay Tore CommaAWeaH BGT 02/24/2022 (ao) ADGE #816 /-BADGE #553 (PSPIMPOETC “Assigned Afiant ID Number & Badge # PA0222400 ‘Police Agency ORT Number) Dl accuse the defendant whose name and popular designation or nickname are unknown to me and whom Ihave therefore desianated as John Doe or Jane Doe with violating the penal laws of the Commonwealth of Pennsylvania at [402] Athens Boro (Sidesorcener in BRADFORD County {08}, (County Code) on or about November 1, 2016 through March 25, 2020 OPC 412A — Rev. 7/18288 POLICE CRIMINAL COMPLAINT [Posternambee Date Fite ‘OTWiLveSean Number ‘Complainvineident Number aE MFI200036314 fan a ae First Middle: Last! [Brenan STEPHANIE GWEN KING he acts committed by the accused are described below with each Act of Assembly or statute allegedly violated , if appropriate. When there is more than one offense, each offense should be numbered chronologically. eeneorh & brie summary ofthe facts sulficent to advise the defendant ofthe nature ofthe offenses) charged. Actaton tothe statutes) allegedly volte ‘pithout mors snot suliciont. na summary case, you must ete the specific sections) and subsechon(s ef the statutes) or ordinances) allegedly violated Dene ee ne tim athe tine of the offense mayo included known. In alton, soetal security numbers and financial information (ey, PINs) should not Delisted. I the Identity ofan account must be established ist only the lat four digi, 204 PACCode § 2151-2137), Ese TiSelctaion Conspiracy [Ramone as 60 Oter nso. |” fooord iaoveA Yeo0s 1 [1407 (OG) [ER mee 62 Zee | es 2699 | 110 a Pasta (in) cans Gay ‘CROKE Yonnians one GramoT aay if applicabl id CO interstate Di Safety Zone Cl Work Zone ‘Statute Description (include the name of statute or ordinance); MEDICAID FRAUD - SUBMISSION OF FALSE INFORMATION Acts of the accused associated with this Offense: On or about Nay 7, 2019 and July 3, 2019, a a prindpal or accomplice, the Defendant, ‘Stephanie G. King, dd knowingly or intentonaly present for alowance or payment, fale or fraudulent dams for fumishing services under the Medical Assistance Program and/or knowingly submitted false informatio, fr te purpose of obtaining greater compensation than that to which she was legally eniled and/or knowingly submitted false information forthe purpose of obtaining authorization fr furshing services or merchandise under medical ‘assistance. See Afidavt of Probable Cause attached hereto and incorporated haten by reference, Tr atompe Ti Soickation 1 Conepiracy Number of Victims Age 69 or do fasara ieoora tases of 4101 @@ BSB te 1 2 [6 2399 [ato Le i omc Te Pxsotm (iis) Cons Gua” MOBO Cans cose Chere Sate 2 i work Zone ‘Acis of the accused associated with this Offense: On er about Nay 7, 2019 and July 3, 2019, as prndpal or accomplice, the Defendant Stephanie G. Kin, with the intent to defraud er injure anyone, o wth the knowledge tet she fs factatng a faut or juny, alters any wring of eather without their authority. See Afidavt of Probable Cause attached hereto and incorporated herein by reference, tom Solctaton [Tl Gonspian amber 060 or Oger CrAteme 7 Seta Genepacy Number of Visine Age 60 or Oa 4101 (O@ BMBPimeis [2 3” [2399 110 VC PAS (| —— cas case no One TRANS CE 0 CO iterstate Ci satey zone | Ca werkzone Statute Description (include the name of statute or ordinance): FORGERY - MAKES, COMPLETES, EXECUTES, AUTHENTICATES, ISSUES (OR TRANSFERS ANY WRITING ‘Acis of the accused associated with this Offense: On or about May 7, 2019 and Day 3, 2018, asa principal or accomplice, the Defondonk Stephanie G. Kin, with the intent to defraud or injure anyone, or with the knowlege thet she i actating a fraud or injury, made, completes, exceed, authenticate, issued or transferered any writing So that purporpts to be the act of another who didnot authorize that ack, See Ada of Probable Cause attached hereto and incorporated herein by reference, ‘AOPC 412A — Rev. 7/18 Page 2 of &+88 POLICE CRIMINAL COMPLAINT Docket Number Date Filed: OTNILIveScan Number Complainvincident Numer a L MF1200036314_ i i z a] Fist Tiga Tat | Detendantname Eo ‘STEPHANIE GWEN KING TraAtempt olcation nape lumbor of Victims Ago 60 oF Older Offense’ qe50ra Ciesenaae Ti conepiacy ‘Number of Victims Age 60 or Old Oy as [at0t We) Biirmeis [2 F3_ | 2309 110 a an Suse FA Sue (a) — canis ~ — ae — Wee Ofna TRIES Cae acl applicable) “| Dinesate Di Satey zone Di wor zone ‘Statute Description (include the name of statute or ordinance). FORGERY - UTTERS ANY WRITING Acts of the accused associated with this Offense: On or about May 7, 2019 and Aly 3, 2019, pincpal or accomplice, the Defendant, Stephanie G. king, with the intent to defaud or injure anyone or with the knowledge that she i aciitating a fraud or injury, uttered any writing whic she knew tobe forged. See Affidavit of Probable Cause attached hereto and incorporated Naren by reference TiAtompt | Ch Soteiation | C Conspiracy umber ef Vitine Ago 60 or Older sesora sea0an Yeoes o [5 [ai wa) Biimeis [i 3 ast _—Ofonsoe Sbessioe "PA Sao (Te) — Caan Gangs — ~ NOX Ofna Cogs — UCRNTERS Code CD interstate Di satety zone work zone Statute Description (include the name of statute or ordinance): TAMPERING WITH PUBLIC RECORDS ‘Acts of the accused associated with this Offense: From May 7, 2019 trough March 25, 2020, in a continuous course of conduct, as a pindpal or ‘accomplice, the Defendant, Stephanie G. King, dd knowingly make a false etry in or faee aeration of, any record, document or thing belonging to, or received or kept by, te government for information o recor, o required by lw to be kept by others for information ofthe government. See Affdavt of Probable Cause attached hereto and incorporates herein by reference. TisSsoticiation | Ci Conspiracy ‘Number of Vietime Age 60 or Older 189024 12903 “[@2) ERS Tie is 1 F3 Subsection PASide as] —— Cons ce — Nei Ofense Cade —UORNIBAS Came O interstate Di satety Zone Ci Work zone ‘ais of the accused associated with this Offense: From Nay 7, 2019 through March 25, 2020, in a ceninucus course of conduct, as a principal or ‘accomplice, the Defendant, Stephanie G. King, did make, presen or use ay record, document or thing knawing Ito be false, and vith intent thot be taken 235.8 genuine part of information or records See Aidavi of Probable Cause attached hereto and incorporated hereln by relerence. ‘AOPC 412A — Rev. 7/18 Page 3 of B2s POLICE CRIMINAL COMPLAINT Doser Wambor Date Fed: OTHILWeSean Warner Complainneident Rumer L MF1200036314 1 a First: ‘Middle: Last fondant Naina! Ssenemesy | STEPHANIE GWEN KING Datempe Sonciaton onan umber of Vicia Age 60 or dor esi tosora | Tisacanen | C fessainey eee ene 1407 (WO ERetmes [i F3__ | 2699 110 a Saar EK SauG | —— Gama gase ne onan Case VoNBRS TE [uarembor ose 1] Acca Site | ey Theiss] Csattyze | Cl Werk Zone Statute Desc ition (include the name of statute or ordinance): MEDICATD FRAUD - BELOW ACCEPTED MEDICAL TREATMENT ‘STANDARDS Acts of the accused associated with this Offense: From November 10,2017 trough Noverber 8, 2019, a continuous couse OF conduc asa Brnpal or accomplice, the Defendant, Stephane G. King, did knowingly or itetionaly submit a dim for services, supplles cr equipment which are not ocumented in the record in the prescribed menner and are of ite o° no benoit the repent, are below the acrepted medical veatment standards, or are ‘unneeded by the repent. See Afdavit of Probable Cause attached hereto and Inorporeted here by reference 9] ClAtene | C Sonataton | C conenran umber of Vitis Ag 6 or Ole [ee Caen [See [Saar | [mocvemnaeos Oo [s 780-113 (A)G2) TIME 35 1 F 5503 ea _ oR Saini —" sr Si Te] —— Gai Gas —~ ni oa Cass UEARIBNS Cas Fe ae D inet Satay Zone 1 Work zone ‘Slalute Description (iclude the name of sat or ordinance) ‘CONTROLLED SUBSTANCE, DRUG, DEVICE AND COSMETIC ACT OBTAINING POSSESSION OF A CONTROLLED SUBSTANCE BY FRAUD ‘Adis of the accused associated wih this Offense: From November 10, Brindpal or accomplice, the Defendant, Stephanie G. King, acquired or obtained | 2017 though Novernber 8, 2019, in continuous course OF conduct as @ ‘eception or subterfuge. See Affdavt of Probable Cause atached hereto and i possession of a controled substance by msrepresentatio, frau, Forgery, incorporated herein by reference in Di Attempt Di Solicitation | C) Conspiracy | ‘Number of Victims Age 60 or Older tasora ieocan feos Oo fs [7013 G4) BRM time 3s 1 F 5503 1840 Leute Oey aa Px Sie (8s) —— Corns — as ee nes 200s — RRS Tae ee eae There satay Zone Ti work zone ‘Statute Description (Include the name of statute or ordinance): ‘CONTROLLED SUBSTANCE, DRUG, DEVICE AND COSMETIC ACT PRESCIRIBING OUTSIDE THE GOOD FAITH PRACTICE OF MEDICINE ‘Acts of the accused associated with this Offense: From Noverber 10, 2017 tough Nowenbe 9, 2015, na crtnaus Goze f Gada wa ‘rincipal er accomplice, the Defendant, Stehanie G. King, prescribed controled substances that were nt done in good faith in he course ot Gokeceeca Bact, within the scope of the pater relatonship, rn accordance wth treatment princes acepted by 2 resparsble segment ote mechen sock See ida of Probable Cause attached hereto and incorporated herein by reference, oe ‘AOPC 412A — Rev. 7/18 Page Tot F+o POLICE CRIMINAL COMPLAINT Docket Number: Date Filed: ‘OTWiLiveScan Number Complaintineident Ruméer MF1200036314 Fast Mie ast _| STEPHANIE GWEN KING Tratempt Soletation | L) Conspie (amber af Vici Ago 60 or Older 1901 a O Mme oC [Ronis vis heer 1 1407 wa [ER me 2 3 [2699 [x0 —— iSong] Ca ae ne Oa Cae UCRNTBRS CO Beste 1D ventae satay one 1 Work Zone ‘Statute Description (include the name of statute or ordinance): MEDICAID FRAUD - SUBMISSION OF FALSE INFORMAWION Acts of the accused associated with this Offense: From November 1, 2017 trough Febrary 10,202, in a continuous course oF conduct, a5 @ Principal or accomplice, the Defendant, Stephanie G. King, did knowingly or intetonaly present fr alance or payment, fle or fraudulent claims for furnishing services under the Medical Assistance Program and/or knowingly submited fle formation, fr the purpose of obtaining greater compensation than that to which she was legal ented and/or knowingly submitted false fermaton forthe purpose of obtaining authoraton fr furishing services or ‘merchandise under medical assistance. See Afdavit of Probable Cause atached hereto and incorporated herein by erence Tatiompt | C Solctation | C) Conspiracy ‘umber of Vitis Age 60 or Older 1e901A jasc roses o [11-1407 (6) TITLE 62 1 [8 2699 110 eas?“ Ofeniok——— Seon —— Seas PA Sie [a6] —— Chun as ei Oana Cas ——~ GOATS Code (Baia te CO inersiate Salty Zone Ti Work Zone Stalute Description (include the name of statute or ordinance): MEDICATD FRAUD - BELOW ACCEPTED MEDICAL TREATMENT ‘STANDARDS ‘Adis of the accused associated with this Offense: From Novenber 1, 2017 tough February 10,2000, ia cantnuous course Of conduct, as 8 Principe or accomplice, the Defendant, Stephane . King, di knowingly or intentionally submit a lim for Services, supplies or equipment which ae not, ‘documented inthe record in the prescribed manner and are of tle or no benef tothe recent, are below the accepted medical treatment standards, or are ‘unneeded by the recpient. ‘See Aidavit of Probable Cause attached hereto and incoporates herein by reference Tater T Sottation [ET Conepan lamer of Vite Ago 6 or Odor reo0rA ieooaa foo fee o [ia [e22 aay Tmeis [i [r2 [2309 060 goer _“ ores gsios ——" Sse PaSohae (Coa —— ca — poe One CoR—VoRMERS EO TaWDOT Data] AcceaT = pe aru Asc Ti mnertate Safety Zone Work zone ‘Statute Description (include the name of statute or ordinance), THEFT BY DECEPTION ‘Rais of the accused associated with this Offense: from Novenber i, 2017 trough February 10, 020, ha connaoes couse f conduct asa principal or accomplice, the Defendant, Stephanie G. King, intentional rested or reinforced a fale impression, including false impressions as to loa, voli, Intention or other state of mind by submiting fraudulent Claims to the Medicaid Program causing theft of over $100,000.00. See Aida of Provete Cases altached hereto and incorporated herein by reference. ‘AOPC 412A — Rev. 7/18 Poge S of 8388 POLICE CRIMINAL COMPLAINT Docket Number: Date Filed: OTNiLiveScan Number ‘Complainvincident NumtSer MF1200036314 Ceaser Defendant Name Fist ida: Tast. ‘STEPHANIE GWEN KING eee O Attamot Hi sanekes | ‘Number of Victims Ago 60 of Old Oo i 4117 (A)(2) TITLE 18 1 F3, 2699 26A * PRRDOT OTE] aT (appizaniy | kame 9 Ti inerstate Ti salty Zone 11 Work zone ‘Statute Description (include the name of statute or ordinance): INSURANCE FRAUD - FALSE CLAIM Acts of the accused associated with this Offense: From November 7, 2016 trough lune 6, 207, na cantnucus couse of conduct, as a principal ‘accomplice, the Defendant, Stephanie G. King, dd knowingly and with the intent to defraud any instre, presen to insurance companies, Highmark, ‘statements forming a part of, o in support of, aims that contained fase, incomplete or misleading information concerning any factor thing material fo the ‘aims. ‘See Aiavt of Probable Cause attached hereto and incorporated herein by reference, Tatomee Sonanaion — [Ey Gonspra See eves encroua) iesora | ienean” [Tsenenee” sunt of itn fae 6. 3922 a) (BM is [1 [rs [2399 060 Sam — a ee | ae CT inetate TisateyzZone | Ch Work Zone ‘Statute Description (include the name of statute or ordinance). THEFT BY DECEPTION ‘Aets of the accused associated with this Offense: From November 7, 2016 trough Jue 6 2017, na contnous course of conduct, asa principal ‘or accomplice, the Defendant, Stephanie G. King, intentionally created ar reivorced a false impression, inuding false Impressions 2st aw, value, intention or ‘other state of mind by submiting fraudulent Gaims to Highmark causing theft of over $2,000.00. See Aidav of Prebable Cause alached hereto and Incorporated herein by reference Eos see [Caro Number ofVetms Age 60 or Oder fanse | 1es00A iea02a feoos 4117 (2) BiRrmers [a FS | 2699 26A Sioa — "Sania Sas | —— oe GK OM Cale — PORTERS TS Are Dinter Safety Zone TD Werk Zone ‘Statute Description (include the name of stalule or ordinance): INSURANCE FRAUD - FALSE CLAIM ‘Tals of the accused associated with this Offense: From November 1, 2017 trough March 24, 2020, na continuous course of conduc a= @ Drindpal or accomplice, the Defendant, Stephanie G. King, dd knowingly and with the intent to defraud any inser, present to insurance compenics, Fighmar, statements forming 3 part, or in support of, daims that contains false, ncamplete or miseading information concerning any factor ng ‘material tothe dims. See Aida of Probable Cause atached hereto and incorporated heren by reference. ‘AOPC 412A — Rev. 7/18 Page Got B