- Office of Attorney General Maura Healey
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Emalie Gainey
Worcester — A father and son who served as a personal care attendant (PCA) surrogate and a PCA for a family member have been charged with allegedly defrauding MassHealth, the state’s Medicaid program, of more than $10,000 by falsely billing for services not rendered, Attorney General Maura Healey announced today.
A Worcester County Grand Jury returned indictments on Tuesday against Scott Gibeault, age 51, of Southbridge, and his son, Michael Gibeault, age 32, of Webster, on the charges of Larceny over $250 (one count each) and Medicaid False Claims (one count each). They will be arraigned in Worcester Superior Court at a later date.
“MassHealth provides health care to some of our most vulnerable residents and we must defend the program’s integrity,” said AG Healey. “We allege these defendants abused this program for their own personal profit, exploiting our Medicaid system and stealing critical taxpayer dollars.”
In February 2016, Scott Gibeault, acting as the PCA surrogate for his adult son, was indicted by a Worcester Grand Jury on four counts of Medicaid False Claims and four counts of Larceny over $250 by False Pretenses in connection with allegedly defrauding MassHealth of approximately $27,000.
The AG’s Office alleged that he submitted fraudulent timesheets indicating PCA services were provided by individuals, including Michael Gibeault, who were out of state, working other jobs, or unable to provide service because the consumer was admitted to an inpatient facility.
In these new indictments, the AG’s Office alleges that after being initially charged, Scott Gibeault continued to submit fraudulent timesheets between February 2016 and March 2017 that resulted in MassHealth making additional unwarranted payments.
The AG’s Office also alleges that Michael Gibeault, who served as a PCA for his brother, was part of the scheme and knowingly signed false PCA timesheets for submission by Scott Gibeault.
The AG’s Office alleges that between December 2012 and March 2017, Michael Gibeault signed false PCA timesheets for submission to MassHealth for times he could not have provided PCA services because he was working at another job, receiving medical care, traveling or observed not providing services to his brother.
As a result of Michael Gibeault’s conduct of signing false timesheets for submission to MassHealth for payment, MassHealth made nearly $9,000 in unwarranted payments.
The MassHealth PCA Program helps people with chronic or long-term disabilities live independently. MassHealth funds pay PCAs who help disabled MassHealth members with activities of daily living while members receiving the services act as the PCA’s employer. By regulation, PCA services cannot be provided while a MassHealth member is admitted to an inpatient facility or nursing home or while a PCA is employed elsewhere on overlapping dates and times with claimed PCA services.
MassHealth members who are unable to manage the hiring, training and firing of PCAs themselves may have a “surrogate” appointed to act for them (typically a family member or legal guardian). MassHealth does not allow surrogates to provide PCA services, and does not pay them to act as surrogates.
These charges are allegations, and all defendants are presumed innocent until proven guilty.
The cases are being prosecuted by Assistant Attorney General Gregory Matthews and were investigated by Investigator Scott Grannemann, both of AG Healey’s Medicaid Fraud Division, and special agents of the HHS-OIG.
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