Meriden Couple Sentenced In $5.3K Medicaid Fraud Scheme: Officials

MERIDEN, CT — Two Meriden residents were recently sentenced in connection with a Medicaid fraud scheme in which they were paid $5,300 for personal care assistant services they didn’t perform, according to officials.

Eugenio Ortiz, 40, and Maria Perez, 41, were each sentenced March 13 in Meriden Superior Court to three years in prison, execution of that time suspended, with three years of probation, according to officials.

Officials said the defendants paid $2,700 in restitution, with the remaining amount of $2,600.97 to be paid during probation, and were ordered not to act as providers in the Medicaid program.

Ortiz and Perez pleaded guilty in December to one count each of first-degree larceny by defrauding a public community and health insurance fraud.

Ortiz and Perez were enrolled as providers in the Connecticut Medical Assistants Program as personal care assistants, according to a news release. The Department of Social Services operates the PCA program that assists older adults and people of any age with a disability to live independently at home. The intent of the program is to “assist older individuals and those with disabilities to accomplish Activities of Daily Living (ADLs) which provides an alternative to living in an institution,” according to the news release.

“An investigation by the Medicaid Fraud Control Unit determined that between January 2020 and June 2020, Ortiz and Perez were submitting timesheets for payment for PCA services purportedly provided by Ortiz,” officials wrote in the news release. “However, Ortiz was incarcerated at the time for an unrelated criminal conviction and could not have rendered services. The investigation revealed Perez was submitting the time sheets that Ortiz had signed in advance of going to prison.

“By submitting the fraudulent timesheets the couple were paid $5,300.97 by the Connecticut Medicaid Program for services not rendered,” officials wrote in the news release. “By being found guilty to a program-related felony, the defendants are also subject to mandatory exclusion as a health care provider to certain federally funded health programs pursuant to federal and state laws and regulations. Medicaid is a government program that provides health coverage to low-income and disabled individuals and is financed both by the federal and state governments and administered by the Connecticut Department of Social Services.”

Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Medicaid Fraud Control Unit at the Office of the Chief State’s Attorney at 860-258-5986.