Springfield - Two Holyoke residents pleaded guilty yesterday to charges of conspiracy to defraud MassHealth by billing for personal care attendant services that were never provided. A third Holyoke resident is scheduled to enter her guilty plea Monday.
Maria Jusino, 35 and Rafael Belen, 39, pleaded guilty to a one-count Information charging them with conspiracy to commit health care fraud. Aida Hernandez, 59, is scheduled to enter her plea on Aug. 27, 2012.
At the plea hearing, the prosecutor told the court that the defendants engaged in a scheme to defraud the state’s Personal Care Attendant (“PCA”) Program. The PCA Program, funded by MassHealth, the Commonwealth’s Medicaid Program, helps individuals with permanent or chronic disabilities keep their independence, stay in the community, and manage their own personal care. The disabled individual is responsible for recruiting, hiring, scheduling, training, and, if necessary, firing his or her PCA. The disabled individual must track the work performed by the PCA on bi-weekly time sheets. If the disabled individual cannot independently manage the PCA Program, he or she must designate a surrogate to assume those responsibilities. The PCA Program expenses for 2011 were approximately $500 million.
The defendants caused MassHealth to be billed for services that were never provided. For example, Maria Jusino billed MassHealth for PCA services she claimed she provided to two different individuals at the same time. Other examples include the following:
Maria Jusino and Rafael Belen signed times sheets for PCA services for their son that were never provided;
Rafael Belen claimed to be providing for PCA services to his brother-in-law in Holyoke when Rafael Belen was on vacation in Puerto Rico;
Aida Hernandez signed time sheets for PCA services she claimed she was provided to Maria Jusino’s son on the same dates and during the same hours that she was running a day care center in her home; and
Maria Jusino billed MassHealth for PCA services she claimed she was performing for her mother during the same hours that Aida Hernandez was billing MassHealth for PCA services she claimed to be providing to Maria Jusino.
Jusino and Belen are scheduled to be sentenced on Nov. 28, 2012. They each face up to five years in prison to be followed by three years of supervised release and a $250,000 fine.
United States Attorney Carmen M. Ortiz and Susan J. Waddell, Special Agent in Charge of the Department of Health and Human Services, Office of Inspector General (“HHS-OIG”) made the announcement today. The case was investigated by HHS-OIG with the assistance of the Commonwealth of Massachusetts Auditor’s Office, Bureau of Special Investigations and the Commonwealth of Massachusetts, Office of the Attorney General, Medicaid Fraud Division. The case is being prosecuted by Assistant U.S. Attorney Karen L. Goodwin of Ortiz’s Springfield Office.
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