- Office of Attorney General Maura Healey
Media Contact for Husband and Wife Charged With Fraudulently Billing MassHealth for Services for Patient Who Died
Emalie Gainey
Boston — A Dorchester husband and wife have been charged with allegedly defrauding the state’s Medicaid program, known as MassHealth, by falsely billing for services not rendered for a patient during her hospitalization and after she was deceased, Attorney General Maura Healey announced today.
On Monday, a Suffolk County Grand Jury indicted Theodore Gilbert, age 54, and his wife, Madeline Garcia Gilbert, age 51, on one count each of Medicaid False Claims and Larceny over $250. They will be arraigned in Suffolk Superior Court on April 23. Madeline Garcia Gilbert was her mother’s Personal Care Attendant (PCA) surrogate and Theodore Gilbert was her PCA.
The AG’s Medicaid Fraud Division began an investigation after the matter was referred by the U.S. Department of Health and Human Services—Office of the Inspector General (HHS-OIG).
The AG’s investigation revealed that between February 2012 and March 2015, Theodore billed for, with Madeline’s approval, PCA services while Madeline’s mother was in inpatient care. MassHealth was also billed after she was deceased. The AG’s Office alleges that the Gilberts fraudulently obtained almost $18,000 through this false billing.
The MassHealth PCA Program helps people live independently in the community by providing medically necessary physical assistance with personal care needs. Through the MassHealth PCA program, eligible MassHealth members receive assistance with their personal care needs provided by MassHealth PCAs. By regulation, MassHealth does not pay for PCA services provided while a MassHealth member is admitted to an inpatient facility or nursing home.
Under the MassHealth PCA program, the MassHealth member is considered the employer of his or her PCAs. MassHealth members who are unable to manage the hiring, training, and firing of PCAs themselves may designate a “surrogate” 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 case is being prosecuted by Assistant Attorney General Kevin Lownds and was investigated by Investigator Aleksandra Andriyevskaya, both of AG Healey’s Medicaid Fraud Division, with assistance from HHS-OIG and MassHealth. Tempus Unlimited Inc., (formerly Cerebral Palsy of Massachusetts), a MassHealth contractor, also assisted with the investigation.
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Media Contact for Husband and Wife Charged With Fraudulently Billing MassHealth for Services for Patient Who Died
