Pittsfield Man Pleads Guilty to MassHealth Fraud

PITTSFIELD, Mass. — A Pittsfield man has pleaded guilty and been sentenced in connection with making duplicative claims for personal care services, resulting in an overpayment of approximately $82,000 in funds from the state's Medicaid Program (MassHealth), $46,500 of which was paid directly to him, Attorney General Maura Healey announced on Monday.

Frederick Phillips, 56, pleaded guilty in Berkshire Superior Court to charges of Medicaid fraud and larceny more than $250 by false pretenses.

"This defendant defrauded a system that provides vital health-care services to people with chronic or long-term disabilities," Healey said in a statement. "He took advantage of his role as caretaker for his brother to steal taxpayer dollars and divert critical resources from people in need."

After the plea was entered, Superior Court Judge John Agostini sentenced Phillips to two years in the Berkshire County House of Corrections, suspended for a probationary period of three years. During the that period, Phillips must refrain from illegal drug use, enter substance abuse counseling, and is prohibited from being a MassHealth provider.

The attorney general's investigation revealed that between March 2011 and November 2013, Phillips submitted fraudulent information to MassHealth's Adult Foster Care Program. Phillips, the AFC caretaker for his brother, billed MassHealth for AFC services knowing that his brother was receiving duplicative Personal Care Attendant (PCA) Program services at the same time.

MassHealth funds both programs, allowing members with chronic or long-term disabilities to live independently and remain in their communities. In both programs, caretakers assist with daily living activities such as taking medications, dressing, going to the bathroom and bathing. Under AFC regulation, MassHealth will not pay for AFC services if a member is receiving PCA services at the same time.

A Berkshire County Grand Jury returned indictments against Phillips in February 2016.

This case was handled by Assistant Attorney General Evelyn Y. Tang of AG Healey's Medicaid Fraud Division and investigated by Investigators April Waterhouse and Michael Russo, also of the Medicaid Fraud Division. The Boston office of the U.S. Department of Health and Human Services Office of Inspector General assisted with the investigation.