Press Release: 2021-07-26
New Bedford Man Indicted in Connection With Defrauding MassHealth in False Billing Scheme
New Bedford Man Indicted in Connection With Defrauding MassHealth in False Billing Scheme:
AG’s Office Alleges Defendant Engaged in Personal Care Attendant (PCA) Fraud
FOR IMMEDIATE RELEASE: 7/23/2021
BOSTON — A New Bedford man who receives care through MassHealth’s personal care attendant (PCA) program has been indicted in connection with allegedly defrauding the program by falsely billing for services from three PCAs, Attorney General Maura Healey announced today.
A Statewide Grand Jury returned indictments against Troy Fortin, age 49, of New Bedford, on the charges of Larceny over $1,200 (two counts) and Medicaid False Claims (two counts).
The AG’s Office began an investigation after receiving a tip on the office’s Medicaid Fraud hotline. The AG’s Office alleges that Fortin fraudulently billed MassHealth for PCA services he did not receive from two PCAs and for services by a third PCA that were not eligible for payment under program regulations.
The AG’s Office alleges that from May 2015 through January 2020, Fortin billed for services from one of his PCAs who was physically disabled and receiving inpatient hospital treatment, and at other times when another PCA actually was working at a secondary employer or was not physically present at Fortin’s residence. Fortin also allegedly billed for services from a third PCA that are not payable PCA services under MassHealth regulations. Specifically, Fortin directed the PCA to vacuum his home and do laundry – tasks that, by themselves, are not eligible for payment under the PCA program. The AG’s Office alleges that Fortin fraudulently billed MassHealth tens of thousands of dollars for services by these three PCAs.
The MassHealth PCA Program helps people with chronic or long-term disabilities live independently. MassHealth funds pay PCAs who help disabled MassHealth members with activities of daily living while members receiving the services act as the PCA’s employer. PCA consumers are responsible for hiring and training their own PCAs, unless they appoint a surrogate to do so. By regulation, PCA services cannot be provided while a MassHealth member is admitted to an inpatient facility or nursing home or while a PCA is employed elsewhere on overlapping dates and times.
These charges are allegations, and all defendants are presumed innocent until proven guilty.
Members of the public who are aware of similar practices by those involved in the PCA program or by other health care providers should call the Attorney General’s Medicaid Fraud Division at (617) 963-2360 or file a complaint through the Attorney General’s website.
This case is being prosecuted by Assistant Attorney General Anthony R. Vargas and Senior Trial Counsel Elisha Willis and was investigated by Senior Healthcare Investigator Steven Pfister, all of AG Healey’s Medicaid Fraud Division. The Office of the Inspector General and Tempus Unlimited, Inc. provided assistance in this case. The Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award. The remaining 25 percent is funded by the Commonwealth of Massachusetts.