Medway Woman Pleads Guilty, Sentenced to Prison for Defrauding MassHealth and Filing False Insurance Claims
Defendant and Husband Profited More Than $1 Million from the Sale of Medical Products Obtained Through Fraudulent Insurance Claims
BOSTON – A Medway woman has pleaded guilty and been sentenced to one year in state prison in connection with fraudulently billing MassHealth and profiting more than $1 million from the sale of medical products obtained through the filing of false health care claims, Attorney General Maura Healey announced today. She was also ordered to pay $57,288 in restitution.
Denise Alessandrini, age 49, pleaded guilty on Wednesday in Suffolk Superior Court to charges of Filing a False Health Care Claim, Larceny Over $250 (4 counts), Medicaid False Claims (8 counts), Larceny Over $250 by False Pretenses (8 counts), and Conspiracy to Commit Health Care Fraud.
After the plea was entered, Judge Rosalind Miller sentenced Alessandrini to one year to one year and a day in state prison, with five years of probation to serve upon her release. She was also ordered to pay $57,288 in restitution jointly with her husband, Vincent.
Judge Miller also ordered that Denise Alessandrini no longer serve as a surrogate in MassHealth’s Personal Care Attendant Program (PCA), work as a PCA, work in a position of providing patient care, participate in the sale of medical supplies, or have any contact with the victims.
On May 18, Denise’s husband, Vincent Alessandrini, age 52, pleaded guilty in Suffolk Superior Court to charges of Filing a False Health Care Claim, Larceny Over $250 (4 counts), Medicaid False Claims (2 counts), Larceny Over $250 by False Pretenses (2 counts), and Conspiracy to Commit Health Care Fraud. He was sentenced to two years in the House of Correction, suspended for a probationary period of five years.
The MassHealth Personal Care Attendant Program (PCA) helps people with chronic or long-term disabilities live independently and hire personal care attendants to help with their daily living activities. Denise Alessandrini served as a surrogate in the PCA program for her twin daughters and two elderly family members residing in the Alessandrini home.
At various times between September 2008 through April 2014, Denise submitted falsified timesheets on behalf of PCAs that either conflicted with existing work or school schedules or at times when the PCA could not otherwise provide services. Vincent also signed false timesheets and received payment for PCA hours billed in his name while he was working at another job. In total, the defendants obtained $35,288 in payments from MassHealth based on false timesheets for PCA services that were not actually performed.
In accordance with their care, the Alessandrinis’ twin daughters were prescribed specialized adhesive wound care medical dressings for the treatment of a specific health condition. The medical dressings were paid for by Partners Healthcare, and the plan was administered by Tufts Health Plan (THP). In September 2011, THP’s fraud prevention unit initiated an internal investigation after identifying a significant uptick in the number of advanced wound care medical dressings being prescribed and ordered on behalf of the twins. The Alessandrinis’ ordering requests reached a high in the winter of 2012 when Partners paid out $660,000 on a single bandage order.
From January 2011 through December 2013, the Alessandrinis sought and obtained large amounts of prescription wound care dressings, for the purpose of selling them for a profit. They sought out customers on the internet and sold them bandages intended for the girls’ care. Several of those customers pre-paid for shipments of wound care bandages and never received them. Authorities estimate that the Alessandrinis stole approximately $335,000 from customers. As a result of this scheme, the resale of these specialized bandages resulted in a profit of more than $1 million.
A Suffolk Superior Statewide Grand Jury returned indictments against Denise and Vincent Alessandrini in November 2014. Vincent Alessandrini pleaded guilty and was sentenced on May 18. Denise Alessandrini pleaded guilty and was sentenced yesterday.
The case was handled by Assistant Attorneys General Jennifer Cotter and Jennifer Goldstein of AG Healey’s Insurance and Unemployment Fraud Division and Medicaid Fraud Division with assistance from investigators Philip Mantyla and Gregoire Ucuz of the Attorney General’s Office and assistance from the Insurance Fraud Bureau of Massachusetts and the Massachusetts State Police.