For Immediate Release - November 18, 2013

Former Personal Care Manager Pleads Guilty in Connection with Billing MassHealth for Services Not Provided

Defendant Billed for Services for MassHealth Member Who Was Deceased

SPRINGFIELD – A Holyoke woman charged with managing personal care assistance has pleaded guilty to billing the state’s Medicaid program (MassHealth) for services provided by her brother who was in jail at the time, and for a MassHealth member who was deceased, Attorney General Martha Coakley announced today.

Amarilis Pirela, age 34, pleaded guilty today in Hampden Superior Court on charges of False Claims (4 counts), and Larceny Over $250 (4 counts). After the pleas were entered, Judge Edward J. McDonough, Jr. sentenced Pirela to 2 years in the House of Correction, suspended with probation for 5 years. Judge McDonough ordered Pirela to pay $20,000 in restitution.

“This defendant used a position of trust to steal tens of thousands of dollars from MassHealth, diverting resources from those who truly need it.” AG Coakley said. “Our office will continue to aggressively combat healthcare fraud.”

Pirela served as a “surrogate,” essentially a guardian, to manage care for two MassHealth members through MassHealth’s Personal Care Attendant (PCA) Program, which provides in-home care to disabled individuals.  In her role as a surrogate, Pirela signed timesheets certifying that one member received care during a 10-day period while he was in the hospital and for 39 days after he died.  As a result of the false timesheets, MassHealth issued payments totaling approximately $4400.  

Pirela also signed timesheets for payments totaling $15,500 certifying that her brother provided care to another member from July 2009 to September 2009, and from October 2009 to January 2011. Jail records, however, showed that her brother was incarcerated during those periods.

A Hampden County Grand Jury returned indictments against Pirela in February 2013. She was arraigned on March 7, 2013.

The case was handled by Assistant Attorney General Joshua Orr and was investigated by Michael Russo, both of the AG’s Medicaid Fraud Division. Massachusetts State Police assigned to the Attorney General’s Office, Special Agents from the Boston Office of the United States Department of Health and Human Services Office of the Inspector General, and fraud investigators from the State Auditor’s Office assisted in the investigation.

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