Pittsfield Man Among Caretakers Charged With Defrauding State Medical System

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.

Among those indicted is Frederick Phillips, 55, of Pittsfield, who allegedly stole $47,000 from MassHealth by double-billing for PCA and adult foster care services simultaneously between March 2011 and November 2013. Phillips was the PCA surrogate for his disabled brother.

The matter was referred by MassHealth after it 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.

A Berkshire County Grand Jury returned the indictment on Feb. 10.

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 Wednesday, Feb. 17, when 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 Healey's Medicaid Fraud Division, with assistance from U.S. Department of Health and Human Services, Office of the Inspector General (HHS-OIG).

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 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 Healey in a statement. "We allege that these individuals exploited this system and defrauded taxpayers, while at the same time diverting resources from those in need."

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 other individuals charged are:

• Crystal Clark, 36, of Haverhill; indicted by an Essex County Grand Jury for allegedly she submitting fraudulent timesheets as the PCA surrogate for her disabled son. Authorities allege that she billed MassHealth more than $64,000 for services that were not provided.

• Mary Yost, 53, of Middleborough; indicted by a Plymouth County Grand Jury for allegedly double-billing MassHealth for more than $86,000 by billing for PCA and AFC services given to her disabled son simultaneously between May 2009 and April 2014.

• Scott Gibeault, 49, of Southbridge; indicted by a Worcester for allegedly submitting 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.

• Tamekha Lewis-Sturrup, 29, of Dorchester; a criminal complaint was issued against her in Boston Municipal Court  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.