The state’s crackdown on Medicaid fraud continues, with charges filed last week against four more individuals involved with the now-defunct Good Faith Services, a personal care attendant company.
As of this week, the state has charged 45 people associated with Good Faith for allegedly fraudulently billing for services that personal care attendants did not actually provide. All told, the investigations into the company have uncovered more than $628,000 in alleged fraud, wrote Andrew Peterson, director of the state Medicaid Fraud Unit, although some of that money included bills from personal care attendants working for more than one company.
Personal care attendants are home-based health care providers who work for PCA agencies like Good Faith Services, which in turn bill Medicaid. Medicaid pays around $24 an hour to the agency, and the agency must pay the PCA at least half that amount. Medicaid payments to Payments to Good Faith Services were suspended in late November 2013.
Client manager charged with $44,000 in fraud
Charging documents filed on April 3 identify Miki Kim as a client manager for Good Faith Services. Kim is alleged to have billed $44,663 in PCA services she did not provide, to five different Medicaid recipients, over the course of four years.
The largest fraudulent charge was for a Medicaid recipient identified as "C.Y." Kim billed C.Y. for more than $18,000 from 2009 to 2013. Family members stated that Kim had never provided care for C.Y., and Kim was only present during the state’s evaluations of the patient. C.Y’s daughter admitted to forging her mother’s signature to provide fraudulent timesheets to Kim, and that the daughter knew it was wrong. Kim also billed for exercising and walking C.Y., a service the patient said would be impossible, as he is partially paralyzed.
The other four recipients and their families also claimed that Kim never provided any services to them, but would show up to fill out timesheets or make herself food. Medicaid recipient identified as "K.S.," and her daughter Pu McNamara reportedly laughed as the investigator read from the timesheets submitted by Kim, stating that she had never provided a single service to K.S., and McNamara wasn’t even aware that Kim was being paid to provide care for her mother. Kim billed more than $1,200 for services to K.S.
Kim faces two felony charges and a misdemeanor for medical assistance fraud and scheme to defraud.
Husband and wife allegedly pocket PCA’s paycheck
In a separate case, the state alleges that husband and wife Santos Violria Vallangca and Rema Peralta Vallangca pretended to need Medicaid services, while pocketing most of the paycheck of their Good Faith Services PCA Ernesto Rondal Gamponia. The charges also allege that the couple committed fraud in May 2012 along with a different PCA, Elizabeth Miranda, for roughly two months.
The couple’s health was assessed in December 2011. Both reported to need help standing, walking, showering, and other activities, and Rema was observed to be unable to turn on a faucet. Santos was reassessed in February 2013, when he was observed as having difficulty repositioning on the couch and needing the help of a PCA and cane in order to stand up.
In May 2012, the couple traveled outside of the country for nearly a month, and their PCA at the time, Elizabeth Miranda, left the state for more than two months. During this time, Medicaid was billed more than $13,000 in services that were either provided outside of the country -- which is prohibited by law -- or were not provided at all, as Miranda was outside of the country for a month longer than they were. During a March 2014 interview, Santos claimed that Good Faith Services had told him it was OK to bill while out of the country, but declined to name the person at the company who had told him to do so.
The charges also allege that for nearly eight months -- from July 24, 2013 to March 8, 2014 -- the couple prepared fraudulent claims in regards to care they didn’t really need. PCA Gamponia then allegedly submitted these claims, for a total of nearly $36,000.
In late February, investigators videotaped Rema and Santos while shopping at Carrs Safeway. The video allegedly show the couple walking around the store and carrying groceries, activities she had claimed to be unable to do. Santos is seen walking and standing for long periods of time before returning to the vehicle.
In March, Gamponia was interviewed twice. During the first interview, Gamponia said he was providing services to the couple, but in the second interview, admitted that he was only providing light housekeeping services due to a positive TB test in December 2013. Gamponia also said that Santos doesn’t need a walker, and that he gave his entire paycheck to Santos, who in turn paid him $350. Gamponia said that Santos told him to lie when asked what services he provided, and that if he didn’t lie, he’d go to jail.
The Vallangcas face six charges total -- five of which are felony charges -- and Gamponia faces three felony charges for the alleged fraud.
Medicaid fraud crackdown
The charges are a continuation of a crackdown in fraudulent Medicaid payments that the Medicaid Fraud Unit has been ramping up since 2012.
Since October 2012, the Medicaid Fraud Control Unit has charged 76 individuals associated with medical assistance fraud, abuse or neglect. Forty-five of these are associated with Good Faith Services, 23 of which have resulted in convictions, Peterson wrote. In July 2013, the state announced 29 cases with Medicaid fraud charges associated with Good Faith Services, the most filed in a single day in state history.
The investigation into Good Faith Services continues, Peterson said.
Part of the reason for the increased crackdown is that the Medicaid Fraud Unit doubled in size in 2012, from three to six enforcement officers. Targeting Medicaid fraud also became a priority for the state, Peterson said. The state prosecutes cases when somebody steals from a private business, Peterson said, and “there shouldn’t be any difference when people are stealing from state or federal offices.”
Alaska spends roughly $1.5 billion on Medicaid each year, a government program that helps low income individuals gain access to needed medical services.