Three people previously associated with Good Faith Services, a personal care attendant agency in Anchorage that had its privilege to submit Medicaid payments suspended after investigators discovered systemic fraud, have been charged with misdemeanor medical assistance fraud.
Analiza Yumul Pentecostes and Philip C. and Agnes Franciso are the owners of Anchorage Adult Day Services, which also has been charged an as organization with a misdemeanor. Adult Day is a home and community-based service provider that bills Medicaid for providing adult daycare around Anchorage.
The charges are the result of unannounced visit to Adult Day by Alaska Department of Health and Social Services investigator James Drayton in late December. According to the criminal complaint filed against the organization and its owners, Drayton was reviewing staffing levels and background clearances for employees.
He allegedly observed Philip Franciso at the workplace and asked him "directly if he had a valid background check." Philip allegedly admitted he did not and could not get a check because he needed a variance, an exemption document required when someone has a criminal history and is unable to pass a background check.
The investigator allegedly reviewed Philip's criminal history and found the social worker was previously busted for a felony crime, though he received a lesser charge as a minor. Still, the past criminal charge and lack of a variance barred Philip from billing and working with Medicaid recipients.
"Philip denied dealing with patients and stated that he just did payroll for Anchorage Adult Day," the complaint says. On the day Philip answered questions for investigator Drayton, he applied for a variance. Health and Social Services denied the request about a week later.
Further investigation found Philip had allegedly lied. He started working for Adult Day around July 25, 2013, the same month the state announced a Medicaid fraud crackdown. Charges were filed early July against 29 individuals, the majority of whom were associated with Good Faith Services. Since then, a total of 45 Good Faith employees have been charged with over $628,000 in Medicaid fraud.
Philip had previously applied for a variance to work as a Medicaid biller at Good Faith Services. He said he was just doing payroll at Adult Day, but it turned out he'd submitted bills to Medicaid to the tune of $175,293, the complaint says. In order to submit those bills, he needed to review patient documents to determine what services were given. His office was also allegedly located past the organization's front desk and through two treatment rooms, a location that would have made it "impossible for Philip to avoid contact with Medicaid recipients."
A biennial report for Adult Day filed with the state allegedly revealed Philip was 77 percent owner of the organization.
Next, Philip's mother Agnes Francisco was interviewed about her son and the ownership of the service provider. The previous owner left in July and asked Philip to take charge, and he cut ties with Adult Day after investigator Drayton showed up unannounced in December, the complaint says. Agnes as well as Pentecostes were previous co-owners of Good Faith Services. Neither of the women were charged in the initial crackdown nor have criminal records, though Agnes is part of a civil lawsuit against her former operation.
Agnes allegedly admitted she knew her son had a past criminal conviction.
Pentecostes told the investigator she'd asked Philip for a variance but he was a "stubborn kid." She'd allegedly been asking him to get the document since July. Philip was terminated in January after the visit from the investigator, she allegedly said.
"Analiza Pentecostes was also a co-owner of Good Faith Services and an owner of numerous assisted living homes in Anchorage and was aware of the background check and variance requirements," the complaint says.
The three defendants face potential fines for the misdemeanor. But the monetary penalties may multiply, as Alaska law allows fines of up to $75,000 for organizations convicted of medical service fraud misdemeanors.