Alaska's Medicaid Fraud Control Unit, which has recently taken steps to target state residents scamming the system, announced Tuesday that criminal charges have been filed against 28 Anchorage-based personal-care attendants for failing to provide care to Medicaid recipients. A single Medicaid recipient was also charged with fraud. Together, that's the most charges filed in a single day for Medicaid fraud in the state's history.
In all, the 29 cases, all associated with Good Faith Services, represent Medicaid paying $362,000 for fraudulently billed services.
Employees of the company allegedly were not caring for recipients living in Chugach Manor and the Chugach View Apartments, low income housing facilities operated by the Alaska Housing Finance Corporation.
An initial review of the charges revealed numerous personal-care attendants were making more than $100,000 a year; one PCA made more than $275,000 in two years. Many others charged netted just a pittance for their efforts.
Good Faith provides Medicaid personal care, transportation and coordination services to eligible recipients of the federal entitlement program.
According to the charging documents, the state's investigation uncovered a number of fraudulent schemes, the majority of which involved Good Faith employees and personal care attendants working for the agency billing Medicaid for services never provided. At times, the attendants would submit the bills while traveling out of the country, said John Skidmore, the Alaska Department of Law Criminal Division director.
Attendants also allegedly billed Medicaid for overlapping time.
On the single occasion when the Medicaid recipient schemed along with the attendant, splitting the funds provided for frequently billed services, the duo bilked Medicaid out of about $23,000, Skidmore said. And although Elisaia Siluano, 52, was diagnosed with diabetes, arthritis, hypertension, morbid obesity and lumbago and approved for 33.5 hours of personal care assistance hours per week, he allegedly admitted he was not in need of Medicaid services.
The state Department of Health and Social Services (DHSS), which tipped off investigators about the alleged fraud, suspended all of the charged personal care attendants from participating in the Alaska Medicaid program -- they can no longer bill Medicaid for services.
The court deemed three of the charged individuals as flight risks: 55-year-old Rocky Kyung Kim, 21-year-old Julien A. Miranda and 32-year-old Bryan F. Pentecostes. The others are not in custody.
An abundance of time and timesheets
Kim faces six counts of Medicaid assistance fraud, including two class C felony counts, which can result in a maximum sentence of five years, but first-time offenders generally get no prison time to two years.
On April 4, a DHSS employee received a complaint from Chugach Manor's service coordinator, alleging that Medicaid recipient Im Soo Roland was not receiving care. Good Faith billed Medicaid for services rendered to Roland for nearly seven months, according to court records.
Kim was interviewed a few days later regarding Roland's care, and he acknowledged his employment at Good Faith since 2011.
The defendant had submitted timesheets to Good Faith claiming he provided 90 minutes of care each day, which consisted of dressing, bathing and mobility, among other services. He allegedly admitted to not providing those services to Roland.
Roland said Kim only helped with translation and playing a movie for her and other seniors at the Anchorage Senior Activity Center. Roland's family confirmed the lack of help, too, according to court records. In total, Kim billed $7,170.90 for services never provided to Roland.
Roland told investigators on at least two occasions Kim gave her $200, stating the money was for his lack of help. Kim allegedly instructed her to not tell anyone because he could get in trouble.
And Kim's sister, another PCA at Good Faith, joined in on the alleged scheme. Myong Dahlberg claimed she took Roland to church, helped her pick out clothing and occasionally cleaned her toilets. Court records suggest Dahlberg never visited Roland's home.
Kim's compensation could be as high as $133,000 per year based on the total number hours of services billed to Medicaid for his recipients, according to court documents. The payment would require 3,500 hours of care weekly.
According Kim's indictment, the defendant has a history of trying to intimidate Medicaid recipients. For example, the state agency that handles Alaska's Medicaid program received a complaint on Nov. 8, 2012 from a former Good Faith customer. Kim allegedly was harassing the woman in hope that she would continue to sign timesheets.
The two other arrested assistants are charged with defrauding Medicaid of about $1,500.
Aggressive enforcement of violations
Alaska spends about $1.5 billion each year on Medicaid, a government program that helps low income individuals gain access to needed medical services. Rides to the pharmacy or a doctor's visit can be covered, as can in-home care from a personal assistant. Duane Mayes, director of the DHSS Division of Senior and Disability Services, said there are two types of care provided by personal care attendants: activities of daily living, such as driving and taking medication, and instrumental activities, such as housekeeping. He could not say whether recipients' quality of the life suffered because of the schemes.
Mayes said the division is working to ensure Medicaid recipients affected by the alleged fraud are receiving care.
"The Alaska Department of Law is committed to the aggressive enforcement of violations of the Medicaid program," Skidmore said. "Medicaid fraud will be aggressively pursued and prosecuted where appropriate. The teamwork that resulted in the charges ... was the collaboration between state and federal agencies, but it's something that they can't do alone. There were also many citizens involved in bringing about the charges today."
Contact Jerzy Shedlock at jerzy(at)alaskadispatch.com