More than 25 caregivers paid by the state to help elderly and ill Alaskans with basic tasks -- dressing, bathing, cleaning house, grocery shopping -- failed to do the work but billed the state anyway, state and federal officials said Tuesday in announcing a major Medicaid fraud investigation.
The personal care assistant program is intended to help individuals stay in their own homes rather than go into assisted living or a nursing home.
Charges were filed Tuesday against 29 individuals, according to state prosecutor John Skidmore, head of the criminal division in the Department of Law. The state posted criminal complaints on the Medicaid Fraud Control Unit web page.
In at least two cases, the person who was supposed to receive the care -- but didn't -- is accused of participating in the scheme by taking a cut from the caregiver, a review of the court cases shows.
The state has never before filed so many Medicaid fraud charges in a single day, Skidmore said.
"And the amount of money we are talking about for citizens within the state of Alaska is the largest amount that we've gone after folks for in the history (of the state) as well," he said.
The state says the Alaska Medicaid program paid more than $362,000 for services that were fraudulently billed.
The charges include felony and misdemeanor accusations of medical assistance fraud and in at least one case, evidence tampering. The fraud in some cases took place for months, in others for several years, the charges say. Some date back to actions from 2008.
In a number of the cases, sons and daughters were providing the care for their parents, which is allowed under the Medicaid rules. Some of the questioned billings came for time periods when the caregiver was working another job or when either the caregiver or the care recipient were out of the country, the charges show.
Most of the care providers charged in the new investigation worked through a business called Good Faith Services LLC that handled their Medicaid billings. All of the personal care assistants have been barred from any further billing of Medicaid, Skidmore said.
Good Faith Services is not charged in the case and is cooperating with the investigation, said its lawyer, Chester Gilmore. The six-year-old company remains in business, he said.
"The business, which is not charged with any wrongdoing at this point, is as shocked and concerned as anyone and hopes that the law is fully enforced with respect to these individuals," Gilmore said.
Medicaid paid Good Faith Services $24 an hour for caregivers, of which Good Faith paid the caregivers $16.50, he said.
Most of the charges arise from billings for services that never were provided to residents of Chugach Manor and Chugach View, apartments for low-income seniors in East Anchorage.
Some of the frauds came to light early this year after a 91-year-old resident complained that a Good Faith employee pressured her to receive care.
One case is against Rocky Kyung Kim, 56, and his sister, Myong Suk Dahlberg, 60.
Kim billed Medicaid for 90 minutes a day for one Chugach Manor resident that he was supposed to be helping between August 2012 and March 2013 with dressing, bathing, getting to the bathroom and generally getting around. But he didn't do the work and wrongly billed $7,170, the complaint said. His sister then took over, billing $734, also without providing the care, according to the criminal complaint.
The Chugach Manor resident told investigators that a few times, she said, Kim gave her $200 and told her to keep quiet. He wanted her to tell investigators he was helping her -- which was captured by a secret recording made by an informant working for investigators, the complaint said.
In the past, Kim harassed or intimidated Medicaid recipients to pressure them to sign up for services, the document said. When one woman transferred her care to another agency, Kim threw rocks at her house late at night, the charges say.
Other cases were revealed after the death in January of Susan Choe, a Medicaid recipient. She was found alone in her home with gates set up to barricade her, according to the charges filed against her son, Joshua Choe, 63, and Tong Sun Cunning, 53. Adult Protective Services found unused medications in her home, raising questions about whether she had gotten the help she needed.
Her personal care assistant was Cunning, the charging document says. Cunning and Joshua Choe were working with a dozen different Medicaid recipients. Cunning billed Medicaid for services during periods she was out of country, for overlapping times and sometimes for more than 24 hours a day -- $86,802 in fraudulent billings in all, the charges say. Choe is accused of signing her timesheets and of himself billing Medicaid for $14,217 in services he didn't provide.
State and federal officials say they are reviewing practices to better stop fraud. The investigation drew on numerous agencies.
"It's my responsibility to make sure that every penny is accounted for," Duane Mayes, director of state Senior and Disabilities Services, told reporters. "This program is very valuable. It's allowing an individual to stay within their own community, their own home."
Prosecutors urge anyone who suspects Medicaid fraud to call 1-800-447-8477 or 269-6279 or report it online through the state Medicaid Fraud Control Unit.
Reach Lisa Demer at firstname.lastname@example.org or 257-4390.