Medicaid Fraud Control Unit Reports 26 Convictions for Medical Assistance Fraud Since October 2013
January 24, 2014
The Medicaid Fraud Control Unit (MFCU) successfully prosecuted 54 year old Clarita Rivera Meneses and 45 year old Romano Clarita Meneses for lying about, and collecting money for, providing personal care services to a Medicaid recipient. In fact, the evidence showed the Medicaid recipient was not in Alaska, let alone the United States, when the Meneses represented they had provided the assistance. The court sentenced the Meneses on January 23, 2014. This is just one of 26 convictions the MFCU has secured since October of 2013, resulting in $105,450.39 in restitution for the State of Alaska.
The case against the Meneses arose when the Department of Health and Social Services received a report that the Meneses were billing Medicaid for providing personal care assistant (PCA) services to a Medicaid recipient when the recipient J.M. was actually in the Philippines. The investigation conducted by the MFCU confirmed that Romano Meneses submitted timesheets to Medicaid on five different occasions for providing PCA services to Medicaid Recipient J.M. when J.M. was actually outside of the United States or on other unapproved travel for a total overpayment of $18,425.61. The investigation conducted by the MFCU also confirmed that Clarita Meneses submitted timesheets to Medicaid on three different occasions for providing PCA services to two different Medicaid recipients when the recipient was actually outside of the United States or on other unapproved travel for a total overpayment of $13,292.71.
PCAs are enrolled with Medicaid as health care providers that the Alaska Medicaid Program pays to provide home based healthcare services which allow Medicaid recipients to stay in their home rather than be placed in a nursing home type setting. The PCA are required to fill out a contemporaneous timesheet for the work done. State law prohibits the submission of false timesheets and/or claims for PCA services provided during periods of international travel or unapproved domestic travel.
Based on the aforementioned evidence, Romano Meneses was convicted of one count of Medical Assistance Fraud for making a false entry in a medical assistance record and ordered to pay a $3,000 fine, 210 days of suspended jail, 180 hours of community work service, and pay restitution of $18,425.61 to the Department of Health. Clarita Meneses was convicted of one count of Medical Assistance Fraud for making a false entry in a medical assistance record and ordered to pay a $2,500 fine, 180 days of suspended jail, 120 hours of community work service, and pay restitution of $13,292.71 to the Department of Health and Social Services. Both defendants were placed on probation for a period of five years and prohibited from billing Medicaid for any services during this time.
The Alaska MFCU is part of the Attorney General’s Office. The MFCU is responsible for investigating and prosecuting Medicaid fraud and abuse, neglect or financial exploitations of patients in any facility that accepts Medicaid funds. The information filed in each case can be found on the MFCU website.
CONTACT: Assistant Attorney General Andrew Peterson at 907-269-6292. For more information about the Meneses cases or other cases handled by the Alaska MFCU, go to the MFCU website.
# # #