FOR IMMEDIATE RELEASE
(Rocky Hill, CT) - A Waterbury man has been sentenced in Hartford Superior Court for defrauding Medicaid by providing behavioral health services to Medicaid clients and billing Medicaid for those services while he was excluded from the Medicaid Federal / State Healthcare Program because of a previous criminal conviction.
On June 20, 2024, the Honorable Courtney M. Chapin sentenced Elijah Caldwell, age 43, to three years in prison, execution of that time suspended, and three years of conditional discharge. The defendant was ordered to and paid $25,000 in restitution. He was also ordered not to act as a Medicaid provider.
By being found guilty of a program related felony, the defendant is also subject to mandatory exclusion as a Healthcare provider to certain federally funded health programs pursuant to federal and state laws and regulations. Medicaid is a government program that provides healthcare coverage to low income, disabled and elderly individuals and is financed by both federal and state governments.
Caldwell pleaded nolo contendere and was convicted of Health Insurance Fraud, in violation of Connecticut General Statues § 53a-442. Health Insurance Fraud is a Class B felony.
An investigation by the Medicaid Fraud Control Unit of the Chief State’s Attorney’s Office determined that between October of 2019 to January of 2020, Caldwell, who was previously excluded from participation in any capacity in Medicare, Medicaid and all Federal Health Care programs for 10 years, did provide behavioral health services and administered the day-to-day operations of Primal Mental and Physical Health (PMPH), a business which was located in Oakville, Connecticut.
The submission of claims by Elijah Caldwell, to the Department of Social Services (DSS), knowing they contained false, incomplete, deceptive and misleading information, constitutes the crime of Health Insurance Fraud.
The case was investigated and 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, the United States Department of Health and Human Services Office of the Inspector General, the Connecticut Attorney General’s Office and the Rocky Hill 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 for the fiscal year of October 1, 2023 through September 30, 2024. The remaining 25 percent, totaling $996,099 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 Chief State’s Attorney’s Office at (860) 258-5986.