The owner of the Elegant Clinical Corporation in East Windsor is charged with billing Medicaid for services that were never provided to the purported recipients.
KAREN GASTON, age 39, of Austin Brook Drive in East Granby, was charged Tuesday with one count each of Larceny in the First Degree by Defrauding a Public Community, Health Insurance Fraud and Criminal Attempt to Commit Larceny in the First Degree by Defrauding a Public Community.
According to the arrest warrant affidavit, a 2018 audit of Elegant Clinical Corporation Medicaid billings by the Connecticut Department of Social Services, which administers the state’s Medicaid program, revealed a 57% error rate in which Medicaid was billed for services not provided. Subsequent investigation disclosed numerous conflicting claims, where the client was actually being treated elsewhere on dates billed by Elegant Clinical. Additionally, most of the visits billed by Elegant Clinical were supported by false or blank documentation in the clients’ files. In all, Medicaid was falsely billed $52,648.97 for ten clients that never received the billed-for services.
Medicaid is a federal and state-funded program that provides health care for low and no-income individuals.
Gaston was released on a $75,000 non-surety bond and is scheduled to appear in Hartford Superior Court, G.A. No. 14, on September 30, 2020. The charges are merely accusations and Gaston is presumed innocent until and unless proven guilty.
Larceny in the First Degree by Defrauding a Public Community and Criminal Attempt to Commit Larceny in the First Degree by Defrauding a Public Community are both class B felonies, each punishable by up to 20 years in prison. Health Care Fraud is an unclassified felony punishable by up to 5 years in prison.
The case is being prosecuted by the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney. The Unit is grateful for the assistance it received in this investigation from the state Attorney General’s Office, the Department of Social Services and the Rocky Hill Police Department.