St. Jude Home Care Owner, Worker, Charged with Medicaid Fraud

The owner of St. Jude Home Care in Cranston along with her director of clinical services are facing various charges relating to fraud scheme in which they bilked the federal government out of $785,000 in Medicaid payments, the Rhode Island Attorney General announced Tuesday.

Priscilla Pascale, 54, of Barrington, the owner of St. Jude, is facing five counts of Medicaid fraud and five counts of conspiracy to commit Medicaid fraud. Orfa Lemaire, 37, of East Greenwich, was charged with five conspiracy counts for her role in the scheme as director of clinical services as they placed unlicensed certified nursing assistants in patients’ homes and filed fraudulent claims.

The investigation began after a discovery during a routine audit by the Rhode Island Executive Office of Health and Human Services Program Integrity Unit.

They saw that St. Jude was sending billing forms with what looked like altered dates that “raudulently reported in-home nursing surveys had been conducted on high-acuity patients,” said Attorney General Peter F. Kilmartin in a statement. ”While checking further into that aspect of the case, the Program Integrity Unit discovered what is alleged to be time sheets for billing that had been submitted by persons who were not licensed CNAs.”

Once referred to the Medicaid Fraud Control Unit at the Office of Attorney General, a formal investigation was initiated.

Through a separate action by the United States Health and Human Services Centers for Medicare and Medicaid Services (CMS) St. Jude’s certification was revoked last July as a result of a deficient compliance inspection, thereby terminating the company’s ability to receive payments from Medicare. On July 20 of 2014, EOHHS also suspended St. Jude from participation in the RI Medical Assistance Program.

Pascale was arraigned today in Providence County Superior Court. She was released on $10,000 personal recognizance. A pre trial conference is scheduled for June 29, 2015. Orfa is scheduled to be arraigned in Providence County Superior Court on April 28, 2015.