An Anchorage woman was sentenced Thursday for the largest Medicaid fraud discovered since the state announced its focused effort to convict such scammers. A Superior Court judge ordered 54-year-old Tong Sun Cunning to return the nearly $90,000 she falsely billed to the health care program.
Cunning billed Medicaid for services she claimed to have provided as an elderly woman's personal care assistant while she was out of the country, for overlapping times and in one instance for more than 24 hours worked in a day, according to the charges.
She pleaded guilty to a single charge of medical assistance fraud, a class C felony, in November. In exchange, the state dismissed the additional fraud-related charges.
Appearing in court wearing a teal and navy blue sweater, Cunning tried to control her sobbing as a Korean interpreter translated the parties' arguments. Toward the end of the hearing, she stood and told the judge she was very sorry for her actions.
State prosecutor Andrew Peterson requested the court impose four to eight months jail time, but Superior Court Judge Philip Volland opted for a year and a half of suspended time and five years of probation in addition to the tens of thousands of dollars in restitution.
Volland said isolating Cunning from the public was unnecessary. She lacks a criminal record, and it's "unlikely she'll repeat her criminal behavior in the future," he said. The suspended sentence makes jail time a reality if she breaks the law again.
Bilking Medicaid out of $100,000
Cunning billed Medicaid $86,802 for assistance she was supposed to provide Susan Choe. Cunning was Choe's personal care assistant; she had her timesheets signed by the woman's son, Joshua Choe, who was also a PCA. Together, the two caretakers were working with a dozen different Medicaid recipients.
When Susan Choe died, she was found alone in her house with baby gates barricading her inside her residence. Unused medications, which she should have been taking with the help of Cunning or Joshua Choe, were found among her belongings. The Medicaid Fraud Unit investigated the death and discovered Cunning billed Medicaid for her time, supposedly spent helping the elderly woman, when she was out of the country.
On one trip in December 2009, Cunning traveled to South Korea, and while abroad she provided a timesheet indicating she'd worked 103 hours in a single week. She told an investigator Joshua Choe had worked as a "backup," for which she paid him. She then said she filled out the timesheets in advance and faxed them from overseas.
Investigators also pored over overlapping timesheets submitted by Cunning and found she overcharged Medicaid by about $67,000.
Joshua Choe was found to have fraudulently billed $14,217 to Medicaid. He also reportedly submitted bills while traveling.
He pleaded guilty to a single misdemeanor count of medical assistance fraud in November. The state dismissed two additional felony charges as part of the plea deal. In addition to full restitution, the court imposed a $5,000 fine and 180 days suspended jail time.
As for the conditions in which Susan Choe was found dead, Peterson said it was a separate matter and he could not comment.
Robin Hood scenario
Since the state began actively pursuing cases of Medicaid fraud about 16 months ago, Alaska prosecutors have identified 71 instances of the financial crime. Forty-five of those cases have resulted in convictions, all with suspended sentences.
Peterson said the state receives $1.5 billion in Medicaid funding, and $150 million of that pays personal care attendants. PCAs are licensed and registered health care providers the state pays to provide daily services to Medicaid recipients, generally so those in need can stay home rather than be placed in a nursing home. The system, Peterson argued, is built on trust. Many PCAs are family members of the recipients, and there is limited oversight to ensure they're providing adequate help. The Medicaid Fraud Unit investigates claims of fraud if they receive credible allegations. Susan Choe's death prompted a review of her care.
Emphasizing the large amount of money Cunning stole from the federal government -- Medicaid fraudsters are generally charged with pocketing between $5,000 and $10,000 -- Peterson said imposing jail time would be appropriate to deter others. "Simply because you don't believe anyone's watching" doesn't make it right, the prosecutor said. "Those charged are generally good people. They'd never steal a TV from the store. But for some reason they tend to think that falsely billing the federal government is OK."
Although the judge decided against jail time, the conviction bars Cunning from ever billing Medicaid again -- that is, unless she gets waivers from the state and federal governments.
Privately-hired defense attorney John Pharr provided Volland with a list of similar fraud cases in which the defendant didn't receive time behind bars. He said his client was a caring woman, and despite the large amount of money she garnered, she shouldn't go to jail.
"She's done a lot of good for a lot of people," Pharr said. "I'd argue it's a steal-from-the-rich-and-give-to-poor-type scenario." According to the charging documents, Cunning said she gave a lot of money to the church.
Now, she'll likely have to file for bankruptcy, Pharr said.