Press Release  Multiple Personal Caretakers Charged with Allegedly Defrauding State Medicaid System more than $230,000

Boston — A personal care attendant (PCA) and four PCA surrogates have been charged with allegedly defrauding the state’s Medicaid program of more than $230,000 by falsely billing for services not rendered and double billing in a number of different cases, Attorney General Maura Healey announced today.

A total of 18 indictments were returned by Plymouth, Berkshire, Essex, and Worcester County Grand Juries and are the result of criminal investigations conducted by AG Healey’s Medicaid Fraud Division. A criminal complaint, including charges of neglecting a disabled person, has also been issued against a PCA who will be arraigned in Boston Municipal Court on March 2.

The cases include allegations of billing MassHealth for services that were not provided, double billing for PCA and adult foster care (AFC) services, and charging for home care when a patient was hospitalized, along with several other schemes.

“MassHealth provides critical healthcare services for people who otherwise cannot afford them,” said AG Healey. “We allege that these individuals exploited this system and defrauded taxpayers, while at the same time diverting resources from those in need.”

The AG’s Office conducted these investigations with assistance from the Massachusetts Executive Office of Health and Human Services and the U.S. Department of Health and Human Services—Office of the Inspector General (HHS-OIG).

“We appreciate the joint effort made to identify and investigate fraudulent billing and practices that put our members’ health and safety at risk,” said Secretary of Health and Human Services, Marylou Sudders. “MassHealth is aggressively auditing and monitoring provider billing practices to ensure program integrity.”     

“Medicaid is designed to provide medically necessary care to some of the most vulnerable people in our society. To scam this program for personal gain is not only reprehensible, it will not be tolerated,” said Special Agent in Charge Phillip M. Coyne of the U.S. Department of Health and Human Services Office of Inspector General. “Working with our state partners, we will continue to make sure that Medicaid funds are spent properly.”

The MassHealth PCA Program helps people with chronic or long-term disabilities live independently. The program provides funds to pay PCAs who help patients 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.

MassHealth members who are unable to manage the hiring, training and firing of PCAs themselves may pick 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. 

The MassHealth AFC program provides for members to receive full-time personal care and requires that the caregiver live with the member. MassHealth contracts with AFC providers to ensure members receive 24-hour direct personal care, and to provide nursing oversight and case management.

The five individuals involved in these cases are:

CRYSTAL CLARK

An Essex County Grand Jury returned indictments on Feb. 11 against PCA surrogate Crystal Clark, age 36, of Haverhill, alleging she submitted fraudulent timesheets. Authorities allege that she billed MassHealth more than $64,000 for services that were not provided.

According to authorities, Clark served as the PCA surrogate for her disabled son and allegedly submitted timesheets certifying that more than 4,000 hours of PCA services were provided to him by Clark’s eldest son, boyfriend, and brother between January 2010 and November 2015.

However, the investigation revealed that, during these times, the PCAs identified on the timesheets were often working elsewhere and could not have been providing PCA services. Clark falsely represented that these services were rendered using photocopied timesheets and falsified signatures. 

Clark was indicted on three counts of Medicaid False Claims and three counts of Larceny over $250 by False Pretenses. She will be arraigned in Essex Superior Court on March 7.

The case is being prosecuted by Assistant Attorney General Julia Smith and was investigated by Investigator Kaleigh Ross, both of AG Healey’s Medicaid Fraud Division, with assistance from Victim Advocate Megan Murphy, of AG Healey’s Victim/Witness Services Division and the State Auditor’s Office.

MARY YOST

A Plymouth County Grand Jury returned indictments on Feb. 16 against Mary Yost, age 53, of Middleborough, alleging that between May 2009 and April 2014, she double-billed MassHealth for more than $86,000 by billing for PCA and AFC services given to her disabled son simultaneously. 

This matter was referred by MassHealth after they received information that Yost was both the PCA surrogate and AFC caretaker for her son and purposely participated in both the PCA program and the AFC program, in violation of MassHealth regulations.

Authorities allege that Yost submitted timesheets reflecting that her other son provided PCA services to her disabled son between June 2011 and April 2014. The investigation revealed that the PCA identified on the timesheets was working elsewhere or in college for some of these time periods so services could not have been provided.

Yost was indicted on one count of Medicaid False Claims and one count of Larceny over $250 by False Pretenses. She will be arraigned in Plymouth Superior Court at a later date. 

The case is being prosecuted by Managing Attorney Lee Hettinger and Assistant Attorney General Evelyn Tang and was investigated by Senior Investigator Michael Russo and Investigator April Waterhouse, all of AG Healey’s Medicaid Fraud Division, with assistance from HHS-OIG.

FREDERICK PHILLIPS

A Berkshire County Grand Jury returned indictments on Feb. 10 against Frederick Phillips, age 55, of Pittsfield, alleging he stole $47,000 from MassHealth by double-billing for PCA and AFC services simultaneously between March 2011 and November 2013. Phillips was the PCA surrogate for his disabled brother.

This matter was referred by MassHealth after they received information that Phillips was both the PCA surrogate and AFC caretaker for his brother and purposely participated in and billed for both programs, in violation of MassHealth regulations.

Phillips was indicted on one count of Medicaid False Claims and one count of Larceny over $250 by False Pretenses. He was arraigned in Berkshire Superior Court on Feb. 17, where he pleaded not guilty to the charges and was released on personal recognizance. Phillips is due back in court on May 2 for a pre-trial hearing. 

The case is being prosecuted by Assistant Attorney General Evelyn Tang and was investigated by Senior Investigator Michael Russo and Investigator April Waterhouse, all of AG Healey’s Medicaid Fraud Division, with assistance from HHS-OIG.

SCOTT GIBEAULT

A Worcester County Grand Jury returned indictments on Feb. 11 against PCA surrogate Scott Gibeault, age 49, of Southbridge, alleging he submitted fraudulent timesheets indicating PCA services were provided by individuals who were out of state, working other jobs, or unable to provide service because the consumer was admitted to an inpatient facility.

The AG’s Office, with assistance from HHS-OIG, began an investigation after it received a complaint alleging Gibeault used a PCA’s signature and falsified PCA timesheets he submitted to MassHealth for payment.

The investigation revealed that between January 2011 and December 2015, Gibeault, acting as the PCA surrogate for his adult son, engaged in multiple schemes that resulted in his theft of approximately $27,000 from MassHealth.

According to authorities, Gibeault allegedly submitted false PCA timesheets between January and December 2015 in the name of his other son for services not provided and at times when the PCA on the timesheets was working at another job.

Authorities further allege that Gibeault submitted false PCA timesheets for hours when the consumer was admitted to inpatient facilities or hospitals and ineligible to receive PCA services.

Gibeault was indicted on four counts of Medicaid False Claims and four counts of Larceny over $250 by False Pretenses. He will be arraigned in Worcester Superior Court on March 8.

The case is being prosecuted by Assistant Attorney General Gregory H. Matthews and was investigated by Investigator Scott Grannemann, both of AG Healey’s Medicaid Fraud Division, and special agents from HHS-OIG.

TAMEKHA LEWIS-STURRUP

A criminal complaint was issued against Tamekha Lewis-Sturrup, age 29, of Dorchester, in Boston Municipal Court on Feb. 12 for allegedly fraudulently billing for approximately $8,600 in PCA services not rendered and for failing to provide services to a consumer resulting in hospitalization.

An investigation by the AG’s Office, in conjunction with HHS-OIG, found that Lewis-Sturrup allegedly submitted fraudulent timesheets indicating she provided PCA services to her father at times when she was found to be working other jobs between April 2013 and January 2014. 

The investigation also revealed that on one occasion, Lewis-Sturrup billed MassHealth for services she did not provide, resulting in her father being taken to the hospital by ambulance and treated for dehydration.

The AG’s Office further alleges that Lewis-Sturrup submitted fraudulent timesheets not under her own name, but under the name of another individual who previously provided PCA services to her father, and then converted the checks made out to that individual for her own benefit.

Lewis-Sturrup has been charged with one count of Medicaid False Claims, one count of Larceny over $250, and one count of Neglect of a Disabled Person. She will be arraigned in Boston Municipal Court on March 2.   

The case was first investigated by HHS-OIG and subsequently referred to AG Healey’s Medicaid Fraud Division. The case is being prosecuted by Assistant Attorney General Stephany Collamore of AG Healey’s Medicaid Fraud Division and was investigated by special agents from HHS-OIG, with assistance from Investigator Andrew Lutynski of AG Healey’s Medicaid Fraud Division.

These charges are allegations, and all defendants are presumed innocent until proven guilty.

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