(Rocky Hill, CT) – An East Hartford woman has been arrested and charged with defrauding the Connecticut Medicaid Health Insurance Program.
Carmen Rivera-Rivera, age 52, of East Hartford, was arrested on September 30, 2026 by Inspectors from the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney and charged with one count of Health Insurance Fraud, in violation of Connecticut General Statutes § 53-442, and one count of Larceny in the First Degree by Defrauding a Public Community, in violation of Connecticut General Statutes § 53a-122(a)(3).
An investigation by the Medicaid Fraud Control Unit found that Rivera-Rivera, was employed by the Adult Family Living Waiver program (AFL). While employed as an AFL caregiver, Rivera-Rivera enrolled to be a Personal Care Assistant (PCA) for the same recipient. The AFL Waiver program is a Medicaid funded program that offers financial assistance and support to family members or friends who act as primary in-home caregivers. These caregivers receive a monthly, tax-free stipend for their services. The PCA program is a Medicaid-funded program which provides recipients who have permanent, severe, and chronic disabilities, funds to hire PCAs to physically assist them with daily self-care activities that enable them to reside in their homes and remain in the community.
From June 25, 2025 through October 9, 2025, Rivera-Rivera submitted time sheets and was paid for providing PCA services to the recipient while being paid for providing AFL services at the same time. The amount she unlawfully obtained, totaling $18,202.98, 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 Rivera-Rivera contained false, incomplete, deceptive, or misleading information which constitutes Health Insurance Fraud.
Rivera-Rivera was released on a $25,000 non-surety bond and has a scheduled court date of October 8, 2026 in Manchester Superior Court, G.A. No. 12. The charges are merely accusations, and she is presumed innocent unless and until proven guilty in a court of law.
Larceny in the First Degree by Defrauding a Public Community and Health Insurance Fraud, are classified as B felonies and are each punishable by up to 20 years in prison.
The case was investigated and will be prosecuted by the Medicaid Fraud Control Unit. The Unit is grateful for the assistance of the Connecticut Department of Social Services – Office of Quality Assurance, and the Newington Police Department.
The Connecticut Medicaid Fraud Control Unit receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $2,612,588 for the fiscal year of October 1, 2025, through September 30, 2026. The remaining 25 percent, totaling $870,858 for the same fiscal year, is funded by the State of Connecticut.
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.