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Medicaid fraud crackdown continues in Alaska

  • Author: Jerzy Shedlock
  • Updated: September 28, 2016
  • Published July 16, 2014

The Alaska Department of Law is continuing its crackdown on Medicaid fraudsters. The total number of criminal cases opened during a nearly two-year period involving health care professionals trying to skim government dollars is approaching the triple digits.

Since October 2012, when the state ramped up its efforts, prosecutors have presented charges in 93 cases, some including multiple defendants. Sixty of those cases have resulted in convictions, said Andrew Peterson, director of the state's Medicaid Fraud Control Unit.

So far this year, 16 cases have worked their way through the legal system and resulted in guilty verdicts, and investigators are continuing to pore over stacks of documents, generating potential new charges. Medical assistance fraud indictments -- frequently filed charges within the Alaska court system during the first quarter of the year -- have been less common lately.

Peterson said the concerted effort to discourage Medicaid fraud is working.

"The hope . . . and, quite frankly, what we're seeing through some of our investigations . . . is that the convictions are deterring individuals," he said. "I think we're having a significant impact in reducing fraud in some areas, but there are other avenues we haven't pursued."

He added there's still a steady flow of work for the investigators.

"I would like to think that the word got out and all fraud stopped, but I'm not that optimistic," Peterson said.

He noted the majority of individuals charged have been home-based health care providers, or personal care attendants. They work for agencies that bill Medicaid, and at least half the payment the agencies get back (generally around $24 per hour) is paid to the attendant.

Personal care attendants get in trouble when they submit overly long timesheets or, for example, when the person for whom they were supposed to provide care is discovered alone and unkempt.

There are other sectors in the Medicaid industry the fraud unit can investigate, Peterson said without giving specifics.

Peterson said a single physician has been charged as well. Dr. Shubhranjan Ghosh is accused of fraudulently billing more than $1 million to the government program in the course of four years. The charges alleged Ghosh and his office manager Nathaniel Carter allegedly billed Medicaid recipients whenever company finances were lagging.

Most cases don't involve so much money. Peterson said the cases are generally settled through plea agreements. The majority of the fraudsters are initially charged with felonies, as any medical assistance fraud offense with more than $500 in bilked funds qualifies for the more serious charge, he said.

Thirteen of the convictions handed down so far in 2014 were misdemeanors. Despite the lesser charges, misdemeanor convictions serve as a solid deterrent, Peterson said. That's because being found guilty of medical assistance fraud, regardless of the level of offense, means that individual is barred for life from billing Medicaid.

The two most recent felony convictions were handed down in late June. Barbara Jean Kanehailua pleaded guilty to and was sentenced for fraudulently billing Medicaid for $94,000.

Department of Labor records revealed Kanehailua claimed she worked for seven different companies and provided services to nine individuals, according to the Department of Law.

"An audit of Kanehailua's Medicaid billing revealed that in 2011, she billed Medicaid for working in excess of 24 hours on 18 different days for a total of $423 in fraudulent billing. In 2012, Kanehailua escalated the practice by billing Medicaid for working in excess of 24 hours on 259 days resulting in a total of $34,731 in fraudulent billing," the Department of Law reported in a news release.

She repeated the practice 13 more times in 2013, the release says. The 56-year-old woman was sentenced to one year of "shock" jail time and ordered to pay back all of the stolen government funds.

A husband and wife were also convicted in June. Katerina Letuane caught the attention of the Medicaid fraud unit when a state-contracted audit uncovered Letuane claimed to provide services to someone who was actually hospitalized at the time.

Her husband, Mile Fainuulelei, also billed Medicaid on "numerous occasions" for services that weren't provided and submitted false timesheets, the release says.

Letuane was sentenced to serve 30 days in jail and pay about $4,900 in restitution jointly with her husband, and was placed on 30 months of formal probation. Fainuulelei received a suspended jail term and was ordered to pay an additional $2,000 fine.