Former Behavioral Health Worker Charged with Falsely Billing $33,000 for Youth Services Not Provided
Defendant Allegedly Obtained $13,000 in Wages Under False Pretenses; Vulnerable Youth Populations Put at Risk
MALDEN – A former behavioral health worker from Malden has been charged with defrauding three MassHealth Managed Care Organizations (MCOs) of $33,000 for youth services that were not provided, and obtaining $13,000 in wages under false pretenses, Attorney General Martha Coakley announced today.
A criminal complaint was issued Wednesday in Malden District Court charging Welch Paul, 31 with Medicaid False Claims (6 counts) and Larceny Over $250 (6 counts). Paul allegedly submitted falsified progress notes in which he claimed to be providing weekly mentoring services to six youths, when he was not actually meeting with them. Paul will be arraigned on July 23.
Paul specifically served as a “Therapeutic Mentor” at Eliot Community Human Services, Inc. (Eliot) in Malden. Therapeutic mentoring is one of several home and community-based behavioral health services that MassHealth offers to members under the age of 21 as part of the Children’s Behavioral Health Initiative by the Executive Office of Health and Human Services. It is a structured, one-to-one, strength-based support service between a mentor and a youth for the purpose of addressing daily living, social, and communication needs.
An investigation by the AG’s Office found that between January 2011 and January 2012, Paul allegedly submitted the falsified progress notes to Eliot. In most cases Paul allegedly met with his assigned youth only a few times in total, but submitted progress notes documenting dozens of meetings, including a trip to the mall on Christmas Eve to shop for gifts with one youth, trick-or-treating on Halloween with another, and a meeting on Thanksgiving Day with a third.
As a result of these false progress notes, Eliot billed three MCOs for approximately $33,000 in services that were not provided and paid approximately $13,000 in wages to Paul under false pretenses. MassHealth MCOs are organizations that contract with MassHealth to provide health care coverage to members who select a managed care plan, and use a network of doctors and other health care providers.
The investigation began after Eliot learned of Paul’s falsified progress notes, conducted an internal investigation, and reported the matter to the Attorney General’s Office. Eliot has cooperated fully with the investigation.
Assistant Attorney General David Scheffler of Attorney General Martha Coakley’s Medicaid Fraud Division (MFD) is prosecuting this case, which was investigated by MFD Investigator Jessica Roy. Massachusetts State Police also assisted in the investigation.