Waterbury Man Charged with Larceny and Health Insurance Fraud
A Waterbury man was arrested today and charged with providing behavioral health services to Medicaid clients and billing Medicaid for those services while he was excluded from the Medicaid Federal / State Health Care Program because of a previous criminal conviction.
Elijah Caldwell, age 39, of Herkimer Street in Waterbury, was arrested by Inspectors from the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney, Connecticut Division of Criminal Justice, on a warrant charging him with one count each of Larceny in the First Degree by Defrauding a Public Community and Health Insurance Fraud.
According to the arrest warrant affidavit, Caldwell, based on a 2018 criminal conviction, was excluded from participation in any capacity in Medicare, Medicaid and all Federal Health Care programs for a period of 10 years. During the time period of October 2019 to January 2020, Caldwell provided biological, psychological and social evaluations, counseling, psychotherapy and physical training sessions while administering the day-to-day operations of Primal Mental and Physical Health (PMPH) located in Oakville, Connecticut. During this time period, PMPH also employed and contracted properly licensed clinicians who were legally permitted to provide services.
The submission of claims to the Department of Social Services for the services provided by Caldwell despite not being legally permitted to perform, contained false, incomplete, deceptive or misleading information which constitutes the crime of Health Insurance Fraud. The amount of money profited by him in the amount of $25,728.68 when he was legally prohibited from participating and billing the program, constitutes the crime of Larceny in the First Degree by Defrauding a Public Community.
Caldwell was released on a $25,000 bond and is scheduled to appear in Hartford Superior Court on February 11, 2021. The charges are merely accusations and he is presumed innocent until and unless proven guilty.
Larceny in the First Degree by Defrauding a Public Community is a class B felony punishable by up to 20 years in prison. Health Insurance Fraud is an unclassified felony punishable by up to 5 years in prison.
The case will be prosecuted by the Medicaid Fraud Control Unit. The Unit is grateful for the assistance it received in this investigation from the state Department of Social Services Office of Quality Assurance, the state Attorney General’s Office, the U.S. Department of Health and Human Services’ Office of the Inspector General, and the Rocky Hill Police Department.