Press Release  AG Campbell Announces Indictments In Worcester-Based Home Health Medicaid Fraud Scheme

Boston — Attorney General Andrea Joy Campbell announced today that the Worcester County Superior Court has returned indictments against four individuals in relation to a wide-spread personal care attendant and home health Medicaid fraud scheme in the Worcester area. The defendants allegedly billed over $500,000 to MassHealth, for home health services that were not provided, including services by personal care attendants (“PCA”), home health aides (“HHA”), or Adult Foster Care (“AFC”) caretakers. The indictments are a result of close collaboration between the AG’s Medicaid Fraud Division, the U.S. Department of Health and Human Services’ Office of Inspector General, Boston Region, and the Worcester Police Department.

Felix Mercedes, of Worcester, was charged with eleven counts, including four counts of Medicaid False Claims, G.L. c. 118E, § 40, one count of Larceny Over $1,200, G.L. c. 266, § 30, one count of Identity Fraud G.L. c. 266 § 37E(c), two counts of Conspiracy to Commit Larceny and Medicaid Fraud, G.L. c. 274 §7, two counts of Witness Intimidation G. L. c. 268 §13B, and one count of Money Laundering, G.L. c. 267§2(2). He is currently held on $25,000 cash bail and subject to a number of conditions, including not working in healthcare or with elderly or disabled individuals. 

Mercedes’ three co-conspirators, Elizabeth Betances Rosario, Yaneris Mercedes De Rivera, and Yenifer Barrera, all of Worcester, were indicted on two counts each of Medicaid False Claims, G.L. c. 118E, § 40, along with various counts of Larceny Over $1,200, G.L. c. 266, § 30.  Each posted $2,500 cash bail and are subject to several conditions including not working in health care or with the elderly or disabled community.   

“The defendants in this case unlawfully exploited vulnerable individuals, including disabled and unhoused victims, in order to cheat the system for their own personal gain,” said AG Campbell. “As thousands across Massachusetts continue to rely on MassHealth to receive critical health care services, my office will continue to hold such bad actors accountable to ensure our public resources are protected for the benefit of those who truly need them.”  

“We are committed to protecting taxpayers and our communities from schemes that target MassHealth and other public health care programs, and we appreciate the continued partnership with the AG’s Medicaid Fraud Division and our local, state, and federal partners,” said Roberto Coviello, Special Agent in Charge of the U.S. Department of Health and Human Services’ Office of Inspector General, Boston Region. 

“The Worcester Police Department Special Crimes Unit works tirelessly to defend vulnerable populations that are often defenseless. This collaborative long-term investigation with the Worcester Police Special Crimes Unit, Attorney General’s Office, and the U.S. Department of Health and Human Services Office of Inspector General is another great example of the dedication and professionalism needed to serve the most susceptible of our populations and protect them from these kinds of crimes,” said the Worcester Police Department.  

The MassHealth PCA program helps people with chronic or long-term disabilities live independently in the community by providing medically necessary physical assistance with personal care needs. Through the MassHealth PCA program, eligible MassHealth members employ PCAs to assist them with their activities of daily living. These services are paid for by MassHealth through a fiscal intermediary. Community based HHA and AFC programs also provide home health services to MassHealth members.   

The indictments allege that on multiple occasions since at least 2019, Mercedes, with assistance from his co-conspirators, fraudulently billed MassHealth for home health services that were not provided. The AG’s Office alleges that Mercedes targeted vulnerable community members, including homeless and disabled individuals, for the scheme, often inviting them to stay in his home. Mercedes then allegedly used the personal information of the victims to sign them up for MassHealth services, including PCA and other home health services, often without their knowledge or consent. The home health services were then billed to MassHealth, despite never being provided.  

The AG’s office alleges that this scheme involved false billing for at least seventeen different MassHealth members, causing many of those members not to receive critical, medically necessary health services that they needed. Mercedes and his co-conspirators allegedly utilized the MassHealth funds for personal expenses, including travel, lifestyle, jewelry, and various luxury items, along with a downpayment on a home in Worcester.  

Additionally, on March 20, 2024, similar indictments were returned to the Franklin County Superior Court related to a separate PCA MassHealth fraud scheme involving a PCA consumer, Brenda Bialecki, formerly of South Deerfield, and two PCAs, John Baracewicz and Isaiah Salaam. The defendants allegedly caused nearly $100,000 in false claims to be submitted to MassHealth for home health services that were not provided and/or were the result of kickbacks.  Each of the defendants were charged with one count of Medicaid False Claims, G.L. c. 118E § 40, one count of Larceny over $1,200 G.L. c. 266, § 30, and one count of Medicaid Kickbacks G.L. c. 118E, § 41. 

All of the above-referenced charges are allegations, and the defendants are presumed innocent until proven guilty.  

The indictments of Mercedes and his co-conspirators were handled by the AG’s Medicaid Fraud Division, with significant assistance from the Office of the Inspector General for the U.S. Department of Health and Human Services, the Office of the State Auditor’s Bureau of Special Investigations, the Massachusetts State Police assigned to the Office of the Attorney General and the Worcester Police Department.  

The indictments of Bialecki and her co-conspirators were handled by Assistant Attorneys General Sean Hildenbrandt and Scott Grannemann, and Investigator Garrett Owens, all of the AG’s Medicaid Fraud Division, with additional assistance from the Office of the Inspector General for the U.S. Department of Health and Human Services. 

Members of the public who are aware of similar practices by those involved in the PCA program or by other health care providers should call the Attorney General’s Medicaid Fraud Division at (617) 963-2360 or file an online complaint. 

The Massachusetts Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $5,865,996 for federal fiscal year 2024. The remaining 25 percent, totaling $1,955,330 for FY 2024, is funded by the Commonwealth of Massachusetts.   

This matter is AG Campbell’s latest effort to further her recently announced strategic priorities to advance opportunity for all across the Commonwealth, particularly through promoting health and safety throughout our state, fostering health equity by combatting harmful MassHealth fraud, and holding accountable those who misuse roles of authority or public trust.   

###