FOR IMMEDIATE RELEASE
(Rocky Hill, CT) - Two Meriden residents were sentenced this month for defrauding Medicaid by billing the government health insurance program for Personal Care Assistant services that they did not perform.
Eugenio Ortiz, age 40, and Maria Perez, age 41, were each sentenced on March 13, 2024 in Meriden Superior Court by the Honorable David Zagaja to three years in prison, execution of that time suspended, with three years of probation. The defendants paid $2,700 in restitution, with the remaining amount of $2,600.97 to be paid during probation, and were ordered not to act as providers in the Medicaid program.
Ortiz and Perez entered guilty pleas on December 13, 2023 to one count each of Larceny in the First Degree by Defrauding a Public Community in violation of Connecticut General Statutes § 53a-122(a)(3) and Health Insurance Fraud in violation of Connecticut General Statutes § 53-442. Both charges are class B felonies.
Ortiz and Perez were enrolled as providers in the Connecticut Medical Assistants Program (CMAP), as Personal Care Assistants (PCA). The Department of Social Services (DSS) operates the PCA program that assists older adults and people of any age with a disability to live independently at home. The intent of the program is to assist older individuals and those with disabilities to accomplish Activities of Daily Living (ADLs) which provides an alternative to living in an institution.
An investigation by the Medicaid Fraud Control Unit determined that between January 2020 and June 2020, Ortiz and Perez were submitting timesheets for payment for PCA services purportedly provided by Ortiz. However, Ortiz was incarcerated at the time for an unrelated criminal conviction and could not have rendered services. The investigation revealed Perez was submitting the time sheets that Ortiz had signed in advance of going to prison.
By submitting the fraudulent timesheets the couple were paid $5300.97 by the Connecticut Medicaid Program for services not rendered. By being found guilty to a program-related felony, the defendants are also subject to mandatory exclusion as a health care provider to certain federally funded health programs pursuant to federal and state laws and regulations. Medicaid is a government program that provides health coverage to low-income and disabled individuals and is financed both by the federal and state governments and administered by the Connecticut Department of Social Services.
The case was prosecuted by the Connecticut Medicaid Fraud Control Unit. The Unit is grateful for the assistance it received from the Connecticut Department of Social Services – Office of Quality Assurance and the Meriden 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 $2,988,308.00 for the fiscal year of October 1, 2023 through September 30, 2024. The remaining 25 percent, totaling $996,099.00 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.