Good Faith Services Personal Care Attendants Sentenced for Falsely Billing Medicaid
Woman Sentenced to One Year in Jail for Fraudulently Billing Medicaid for Over $94,000
June 23, 2014
Anchorage - The Medicaid Fraud Control Unit (MFCU) successfully prosecuted 56 year old Barbara Jean Kanehailua for falsely billing Medicaid for personal care attendant (PCA) services. Department of Health and Social Services (DHSS) employees identified Kanehailua as an individual of concern with respect to the amount of money billed to Medicaid for providing PCA services. Department of Labor records revealed that Kanehailua worked for seven different companies and claimed to be providing services to nine different individuals. Kanehailua was paid a total of $275,229.78 in wages over a two year period for providing PCA services.
PCAs are enrolled with Medicaid as health care providers. Alaska Medicaid Program pays PCAs to provide Medicaid recipients with assistance in activities of daily living, which allow Medicaid recipients to stay in their home rather than be placed in a nursing home type setting. The PCAs are required to fill out a contemporaneous timesheet for the work done. State law prohibits the submission of false timesheets. State law also prohibits claims for PCA services provided during periods of international travel, unapproved domestic travel or during periods in which the Medicaid recipient is hospitalized.
An audit of Kanehailua’s Medicaid billing revealed that in 2011, she billed Medicaid for working in excess of 24 hours on 18 different days for a total of $423.30 in fraudulent billing. In 2012, Kanehailua escalated the practice by billing Medicaid for working in excess of 24 hours on 259 days resulting in a total of $34,731.00 in fraudulent billing. In 2013, Kanehailua billed Medicaid in excess of 24 hours on 13 days for a total overpayment of $1,546.89. The MFCU audit of Kanehailua’s timesheets further revealed that 40% of her Medicaid billings consisted of overlapping time for hours billed resulting in Medicaid paying a total of $94,339.44 for services that were not provided. Kanehailua was able to fraudulently bill Medicaid by simultaneously working as an enrolled Medicaid provider and a provider under an agency enrollment.
Based on the aforementioned evidence, Barbara Kanehailua was convicted on June 23, 2014 of one count of Medical Assistance Fraud, a B Felony, for knowingly submitting a claim to a medical assistance agency with a reckless disregard that the claimant was entitled to the payment. Kanehailua was sentenced to serve one year in jail, pay $94,339.44 in restitution, and serve 10 years of formal probation. Kanehailua will be prohibited for life from billing Medicaid for any services and placed on a nationwide exclusion list prohibiting her from providing services in other states.
Wife and Husband Convicted of Medicaid Fraud
Anchorage - The MFCU also successfully prosecuted 27 year old Katerina Letuane for falsely billing Medicaid for PCA services. In February 2012, the MFCU received a report from a state contracted audit that Medicaid paid Letuane for providing PCA services when the Medicaid recipient was actually hospitalized. The MFCU investigation revealed that Letuane and her husband Mile Fainuulelei fraudulently billed Medicaid on numerous occasions for services that were not provided and submitted timesheets to Medicaid claiming that Mile provided PCA services when he was actually working another job.
Based on the aforementioned evidence, Katerina Letuane was convicted on June 20, 2014 of one count of Medical Assistance Fraud, a class C Felony, for knowingly submitting a claim to a medical assistance agency with a reckless disregard that the claimant was entitled to the payment. Letuane was sentenced to serve 30 days in jail, pay $4,905.48 in restitution jointly with her husband, and was placed on 30 months of formal probation. Mile Fainuuleilei was previously sentenced in Anchorage District Court on July 16, 2013 to a Class A misdemeanor offense and received a sentence of 360 days of suspended jail, a $2,000 fine, and three years of probation. Katerina Letuane and Mile Fainuuleilei will similarly be barred from billing Medicaid and will be placed on a nationwide exclusion list prohibiting both of them from providing Medicaid services in other states.
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 at http://www.law.alaska.gov/department/criminal/mfcu.html. These are three of the 55 cases filed in association with the Good Faith Services investigation being conducted by MFCU, which resulted in 35 convictions and identification of over $700,000 in fraudulent Medicaid billing.
CONTACT: Assistant Attorney General Andrew Peterson at 907-269-6292. For more information about these cases or other cases handled by the Alaska MFCU, go to the http://www.law.alaska.gov/department/criminal/mfcu.html.
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