Notable BSI Activity in Fiscal Year 2019

Over the last year, BSI has secured guilty pleas, convictions, settlements, and other resolutions for instances of public benefit fraud.

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Tewksbury Woman Sentenced for Submitting False Timesheets

On December 13, 2018, a Tewksbury woman was sentenced in Middlesex Superior Court to one year of incarceration in the house of corrections, with three years suspended, after she pleaded guilty to one count of Medicaid false claims and one count of larceny over $250. The defendant, who submitted false timesheets claiming that she provided PCA services to her aunt after the aunt’s hospitalization and death, received a prohibition from providing any service that is directly billed to MassHealth, and she must pay $12,360.00 in restitution. Based on BSI’s investigative efforts and collaboration with the Attorney General’s Medicaid Fraud Division in this case, a Middlesex County grand jury indicted the defendant for allegedly stealing more than $10,000 in MassHealth benefits from September 2016 through April 2017. 

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Boston Resident to Pay Restitution for Public Assistance Fraud

On February 20, 2019, BSI sought to file charges in the Boston Municipal Court, alleging that a Boston woman intentionally withheld her marital status and her spouse’s income from EEC. The defendant collected over $22,000 in childcare benefits during the nearly three-year period of alleged fraud. The woman agreed to a pre-arraignment deal of two years of probation with $1,500 ordered in restitution.

Medford Woman Sentenced for Theft of Government Benefits

On February 26, 2019, US District Court Judge William C. Young sentenced a Medford woman to one year and one day in prison, three years of supervised release, and restitution totaling $108,288. On November 26, 2018, the woman pleaded guilty to three counts of theft of public funds, two counts of making false statements, and one count of falsely representing a Social Security number.

In September 2015, the woman, whose scheme of fraud spanned from October 2007 through May 2017, falsely informed DTA that she did not have income other than her Social Security benefits when, in fact, she was receiving income as a result of her work as a PCA. In March 2016, while the woman continued to work as a PCA, she told Social Security that she did not take care of any other individual. She also falsely represented her Social Security number on a timesheet submitted in connection with her work as a PCA. The subject failed to report her income as a PCA, which resulted in the fraudulent payments of government benefits, which she would not have been eligible for had she truthfully disclosed her income.

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Norwell Dentist Pleads Guilty to Medicaid Fraud and Larceny in Norfolk Superior Court

In August 2018, through the investigative efforts of BSI’s DAU and the Massachusetts Attorney General’s Office (AGO), a Norwell dentist and the corporation she owned were indicted in Norfolk Superior Court on two counts of filing Medicaid false claims and two counts of larceny over $1,200. The dentist’s corporation had been excluded from the MassHealth provider program in a prior court case with the AGO that was resolved through a civil agreement. When applying to open a second location for her corporation, however, the dentist failed to disclose her exclusion from the MassHealth provider program.

On June 21, 2019, the dentist and her corporation pleaded guilty to Medicaid false claims and larceny. The plea agreement includes a sentence of three (3) years of probation, $173,000 in restitution to MassHealth, an $84,000 fine against the corporation payable to the Commonwealth, and a five (5) year exclusion from all Medicare and Medicaid programs; the dentist paid the restitution and fine in full.

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BSI Participation in Document and Benefit Fraud Task Force Continues

As an active member of the U.S. Attorney’s Public Assistance Fraud Task Force, BSI received 32 referrals in FY19. BSI also continued to serve on the Homeland Security Investigation’s Document and Benefit Fraud Task Force (DBFTF), which is comprised of various local, state and federal agencies with expertise in detecting, deterring, and disrupting organizations and individuals involved in various type of document, identity, and benefit fraud schemes.

During an investigation dubbed “Double Trouble,” the DBFTF investigated suspected aliens, predominately from the Dominican Republic, who allegedly obtained stolen identities of United States citizens living in Puerto Rico and then used those identities to obtain documents and public benefits that they would not otherwise be eligible to receive. Most frequently, these benefits included Registry of Motor Vehicles identity documents, Social Security numbers, Medicaid, unemployment compensation, and public housing subsidies. Among other things, a comparison of public benefits records revealed the identities of numerous individuals who received public benefits in both Puerto Rico and Massachusetts on or around the same date.

On July 26, 2018, following a federal sweep targeting offenders of document and benefit fraud, various charges were brought against 25 individuals in federal court in Boston. Many of the defendants had prior criminal histories, including a convicted murderer who escaped from prison in Puerto Rico in 1994 while serving a 40-year sentence. Only four (4) of the 25 alleged defendants were lawfully present in the United States. On August 16, 2018, 12 of the 25 defendants were indicted with various charges of aggravated identity theft and false representation of a Social Security number.

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Date published: January 22, 2020