Multiple Personal Care Attendants Charged with Allegedly Defrauding Medicaid System
Allegations Include Billing for Services while Incarcerated, Working other Jobs, Charging for a Deceased MassHealth Member, and Other False Billing Schemes
BOSTON – Five former personal care attendants (PCAs) and three PCA surrogates have been charged for allegedly defrauding the state’s Medicaid program of approximately $260,000 by falsely billing for services that were not provided in a number of different cases, Attorney General Martha Coakley announced today. The cases include allegations of billing MassHealth for services while a PCA was incarcerated, and charging for the care of a deceased person, along with several other schemes.
A total of 32 indictments were returned this week by Worcester, Hampshire, and Hampden County Grand Juries and are the result of criminal investigations conducted by AG Coakley’s Medicaid Fraud Division. A criminal complaint has also been issued against another former PCA who will be arraigned in Boston Municipal Court in West Roxbury on March 6.
All of the cases were in collaboration with investigators from the Bureau of Special Investigations of the Office of the State Auditor and the Boston office of the U.S. Department of Health and Human Services Office of Inspector General.
“MassHealth is a critical program that provides health insurance for some of our most vulnerable residents,” AG Coakley said. “The brazenness of the fraud committed in these cases is particularly troubling. The defendants allegedly stole more than $260,000 from taxpayers, diverting resources from those who truly need it.”
“These investigations act as a deterrent to criminals and help agencies and vendors better manage Medicaid programs so that benefits are available for those who need them most,” State Auditor Suzanne Bump said.
The MassHealth PCA Program helps people with chronic or long-term disabilities live independently. The program provides funds to pay PCAs who help patients with Activities of Daily Living while members receiving the services act as the PCA’s employer. By regulation, PCA services cannot be provided while a MassHealth member is admitted to an inpatient facility or nursing home.
MassHealth members, who are unable to manage the hiring, training and firing of PCAs themselves, may pick a “surrogate” to act for them (typically a family member or legal guardian). MassHealth does not allow surrogates to provide PCA services, and does not pay them to act as surrogates.
The eight individuals involved in these cases are:
A Hampden County Grand Jury returned indictments on Monday against former PCA surrogate Amarilis Pirela, 33, of Holyoke, alleging she submitted timesheets for services provided by her brother who was in jail at the time, and for a MassHealth member who was deceased.
According to authorities, Pirela served as the surrogate for two MassHealth members and allegedly submitted timesheets certifying that PCA services were provided by Pirela’s brother from July 2009 to September 2009, and from October 2009 to January 2011. Jail records show, however, that Pirela’s brother did not provide the services because he was incarcerated in Massachusetts for illegal possession of a firearm and ammunition.
Pirela also allegedly submitted timesheets over a five week period in 2007 for a member who had died, along with services while that member was hospitalized. Pirela allegedly billed MassHealth for approximately $20,000 worth of PCA services that were not provided.
Pirela was indicted on four counts of Medicaid False Claims and four counts of Larceny over $250 in Hampden Superior Court in Springfield. She will be arraigned at a later date.
The case is being prosecuted by Assistant Attorney General Joshua Orr and was investigated by Investigator Michael Russo, both of Attorney General Martha Coakley’s Medicaid Fraud Division.
MARCY KEEGAN GRENACHE & DANIEL KEEGAN
A Worcester County Grand Jury returned indictments on Tuesday against Marcy Keegan Grenache, 32, of West Boylston, and her brother, Daniel Keegan, 30, of Holden, alleging that they billed MassHealth for more than $93,000 of services that were never provided.
According to authorities, Grenache’s disabled son had been approved to receive PCA services in 2007. Acting as his surrogate, Grenache hired Keegan as her son’s PCA in October 2007. Through October 2011, Grenache and Keegan allegedly submitted fraudulent timesheets for services that were never provided since Keegan lived outside of Massachusetts at the time, traveled extensively, and maintained conflicting employment. Although Keegan divided time between Florida and Tennessee residences, timesheets were submitted to MassHealth for payment on a bi-weekly basis for more than three and a half years.
After the funds were deposited into Keegan’s bank account, large sums of money were allegedly transferred to Grenache, typically by check. In total, MassHealth paid more than $103,000 for services billed under Keegan’s name, but investigators determined that more than $93,000 of that sum was paid to Keegan for services he never provided.
The defendants were each indicted on one count of Medicaid False Claims and one count of Larceny over $250. Both will be arraigned on March 5 in Worcester Superior Court.
The case is being prosecuted by Assistant Attorney General Casey Groff and was investigated by Investigator Brian Merrick, both of Attorney General Martha Coakley’s Medicaid Fraud Division.
JAMES LYNCH & HOLLY-BETH RIOPEL
A Hampshire County Grand Jury returned indictments on Tuesday against James Lynch, 43, of Agawam, and Holly-Beth Riopel, 37, of Palmer, alleging they billed for years of PCA services that they did not provide.
According to authorities, Lynch submitted false timesheets to MassHealth indicating care for a patient while he was working as a bus driver at the Lower Pioneer Valley Educational Collaborative. It is also alleged that Lynch had an agreement with the consumer to inflate his timesheets and pay half of his checks to the MassHealth member. It is alleged James Lynch billed MassHealth approximately $63,000 pursuant to this scheme.
The Commonwealth further alleges that Riopel, a teacher at Palmer Public Schools, billed MassHealth for providing $44,000 in services from 2006 to 2008 that authorities allege were not provided.
Riopel and Lynch were both indicted on one count of Medicaid False Claims and one count of Larceny over $250 in Hampshire Superior Court in Northampton. They will be arraigned at a later date.
The case is being prosecuted by Assistant Attorney General Angela Neal and was investigated by Investigator Scott Grannemann, both of Attorney General Martha Coakley’s Medicaid Fraud Division.
ALAN & JACQUELINE MORRISSETTE
A Worcester County Grand Jury returned indictments on Tuesday against Alan Morrissette, 53, and his wife, Jacqueline Morrissette, 55, of Blackstone, alleging they stole $32,000 from MassHealth as part of three false-billing schemes, all of which involved the consumer not being present in the home.
The case stems from a referral to the AG’s Office by the Office of the State Auditor Bureau of Special Investigations, which identified Alan Morrissette as the highest paid MassHealth PCA in the state during 2009, earning more than $100,000 annually from the program. Morrissette’s wife, Jacqueline, allegedly assisted him in obtaining money for PCA services that were never provided by co-signing timesheets as the surrogate for the two MassHealth members that reside in their home.
In one scheme from 2007 to 2010, the Morrissettes allegedly submitted timesheets for more than 2,000 hours of PCA services rendered to a consumer who was at a day habilitation program located 10 miles away. Another scheme involved allegedly submitting timesheets and being paid for PCA services for MassHealth members who were hospitalized at the time. Finally, the Morrissettes allegedly submitted time sheets on three separate occasions, a total of at least 32 days, while a MassHealth member was admitted to a residential care facility on an inpatient basis.
Alan and Jacqueline Morrissette were each indicted on four counts of Medicaid False Claims and four counts of Larceny over $250. They will be arraigned on March 5 in Worcester Superior Court.
The case is being prosecuted by Assistant Attorney General Ian Marinoff and was investigated by Investigator Gregoire Ucuz, both of Attorney General Martha Coakley's Medicaid Fraud Division.
A criminal complaint was issued against Abel Vega, 29, of Jamaica Plain in Boston Municipal Court in West Roxbury this week, for allegedly billing for PCA services while the MassHealth member he worked for was either hospitalized or in a long-term care facility.
An investigation by the AG’s Office found that between May and August 2011, Vega billed MassHealth for more than 50 hours per week of PCA services while the MassHealth member was inpatient, first at a hospital, and then at a long-term care facility.
Vega has been charged with one count of Medicaid False Claims and one count of Larceny over $250 after allegedly defrauding MassHealth of nearly $9,000. He will be arraigned on March 6.
The case is being prosecuted by Assistant Attorney General David Scheffler and was investigated by Investigators Scott Grannemann and Aleksandra Andriyevskaya, all of Attorney General Martha Coakley’s Medicaid Fraud Division.