Every year, millions of people receive important medical services thanks to Medicaid. Services like this are critical for individuals who otherwise couldn’t afford medical assistance paying out of pocket.
However, it’s not uncommon for individuals to abuse these services in for-profit scams. CDPAP is one of these services.
CDPAP is part of the Medicaid program, providing hiring privileges to patients who receive homebound care. These privileges allow these patients to handpick who they want to provide for them as caregivers.
Normally insurance programs give homebound patients a handful of providers to choose from. In the case of CDPAP, individuals can name whoever they’d like, including friends or family members.
Basically, the individual who patients pick shows up to work on a daily basis to satisfy their hours and schedule. The CDPAP program, or in other words, our federal government, reimburses them for their hours logged in the form of a paycheck.
The goal of the program is to give patients the ability to select an individual that they would feel the most comfortable with. However, many people are taking advantage of these services to line their own pockets.
Medicaid CDPAP fraud is the act of stealing money from the Medicaid CDPAP program. The way individuals complete this process is actually quite simple.
The fraudsters list themselves as the caregivers for the Medicaid recipient. As a result, they collect a weekly paycheck. However, these individuals don’t show up for work.
News coverage has covered many stories that include fraud, just like the type mentioned above. These cases aren’t as widespread as you would think and are becoming common in multiple cities and states. In the section below, we’ve got the biggest news stories regarding the coverage of these fraud cases.
The following list provides some of the most common Medicaid and CDPAP fraud examples.
These two fraudsters out of New York presented themselves to be caregivers but were robbing the system the entire time. Tina and Sean reported to AccentCare of New York, Inc., which is a fiscal intermediary for CDPAP. Basically, these are middle-man companies that provide caregiving services that recipients of Medicaid commonly use.
False timesheets were submitted to AccentCare by Tina and Sean, and the duo ended up paying the price. The end result was the two being charged with Grand Larceny in the Second Degree, offering a False Instrument for Filing in the First Degree, and Falsifying Business Records in the First Degree.
In the end, the two pled guilty and struck a deal with the prosecutor’s office. They received five years of probation and were ordered to pay back restitution of roughly $113,584.48 each.
Emily Portillo, daughter of Enny Portillo, supposedly provided homecare for a Medicaid recipient through the company Priority Home Care Services, Inc. Enny was the recipient’s representative and monitored and verified the care her daughter provided for the individual.
Over time, Emily submitted timesheets that included about $50,000 worth of hours logged providing care for this individual. However, the problem was, during the time the sheets were submitted, the individual was out of the country in Columbia.
Because Enny’s daughter didn’t work and she was aware of it, the mother/daughter duo were both charged with Grand Larceny in the Second Degree, Offering a False Instrument for Filing in the First Degree, and Falsifying Business Records in the First Degree.
In 2020, 10 individuals in New York received numerous charges because of Medicaid fraud. All 10 of these individuals worked for one of two homecare companies operating out of Brooklyn, New York.
Once again, false timesheets were submitted. When these workers were reported to have been with clients, they ran personal errands and engaged in non-work activities. For example, one worker who reported work on a timesheet was actually on a Caribbean cruise instead of caring for a client.
As a result of their scheme, all 10 of these individuals were charged with one count of conspiracy to commit mail, wire, and healthcare fraud. Each of these charges carries a maximum of 20 years in prison. Additionally, they were each charged with one count of wire fraud, one count of healthcare fraud, and one count of conspiracy to violate the Anti-Kickback Statute.
All of these charges carry a maximum sentence of 20 years, except for the latter, which carries a maximum term of five years in federal prison.
Mother/daughter duo Melinda Jones and Bertha Granderson worked for Maxim Healthcare out of Rochester, New York. Apparently, the two took turns providing care for one of their relatives between 2014 and 2015.
In fact, 149 hours’ worth of care, to be exact. Somehow Granderson was also able to work the same hours at her other jobs at restaurants Sonic and Tim Hortons. The pair received about $1,500 each in fraudulent money.
They were both arrested and charged with one count each of Grand Larceny in the Fourth Degree, Falsifying Business Records in the First Degree, and Offering a False Instrument for Filing in the First Degree, all class E felonies.
If there’s one thing apparent after reading the reports of each of these crimes, it’s that states and the federal government aren’t taking these matters lying down. Law enforcement is no longer turning a blind eye to reports of this fraud, and prosecutors aren’t afraid to go after individuals that break these laws.
Charges and sentences are different in each state. The majority of these crimes took place in New York, where they’re all considered very serious offenses. Regardless of the state in question, all of these acts are a felony.
Additionally, abusing the system in this matter ruins these types of services for individuals who truly need them. Milking the government for money and having them pay for services that weren’t received drain taxpayer dollars and end up getting programs like this canceled.
If there’s one thing that’s for sure – with the state of our economy, having programs like this canceled is something recipients of these services absolutely can’t afford.
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