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North Franklin Woman Charged in Scheme to Defraud Medicaid

A North Franklin Woman was arrested today and charge with fraudulently billing the government’s Medicaid health insurance program by submitting billings and receiving payments for services she did not provide.

Dawn Cooley, age 34, of North Franklin, was arrested by Inspectors from the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney, and charged 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, between May 2018 and February 2019, Cooley submitted numerous fraudulent time sheets claiming that she had rendered in-home care for a disabled client. Cooley was employed under the Personal Care Assistance program (PCA), which is a federal and state-funded Medicaid program that provides funds to allow disabled adults to hire assistants for daily care, thus enabling the individual to remain at home instead of being placed in a health care facility.

The alleged scheme unraveled when the Connecticut Department of Social Services, which administers the state’s PCA contracts, discovered that Cooley was concurrently working at a separate health care facility, and her hours of service overlapped her submitted time sheets. Further investigation revealed that Cooley submitted times sheets for overlapping hours as well as billing on other days that she did not go to the client’s residence or render any services. Between May 2018 and February 2019, by submitting billings for services not rendered, Cooley stole $2133.00 from the Medicaid program.

The amount of money profited by her in the amount of $2133.00 constitutes the crime of Larceny in the First Degree by Defrauding a Public Community. The submission of claims to the Department of Social Services provided by Cooley contained false, incomplete, deceptive or misleading information which constitutes the crime of Health Insurance Fraud.

Cooley was released on a $2500 non-surety bond, and is scheduled to appear in Harford Superior Court, G.A. No. 14, on July 6, 2021. The charges are merely accusations and she is presumed innocent unless and until 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 the investigation from the State Department of Social Services Office of Quality Assurance, and the New Britain Police Department.

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