CDPAP is a Medicaid program that provides assistance to chronically ill and disabled New Yorkers in need of home health care. But like other government benefit programs, CDPAP is not immune to fraud and abuse. Here are several stories of caregivers who were convicted of submitting fraudulent claims to Medicaid.
What Is CDPAP?
Consumer Directed Personal Assistance Program (CDPAP) is a New York Medicaid program that allows the elderly, chronically ill, and disabled individuals to choose their own caregivers. A consumer can designate almost anyone among family members and friends to become a paid caregiver and provide assistance with activities of daily living as well as skilled nursing services. The CDPAP caregiver payment is done through private companies contracted by Medicaid known as fiscal intermediaries.
What Is Medicaid CDPAP Fraud?
CDPAP Medicaid fraud is giving false information in order to receive payment for caregiving services. The most common type of CDPAP fraud consists of caregivers collecting paychecks without providing care. For example, a consumer (or a designated representative) and a caregiver may sign a timesheet for hours that the caregiver has not worked and submit this false claim to the fiscal intermediary for payment.
The New York State Federal False Claims Act imposes liability on anyone who knowingly submits a false claim to the federal government. A person who is found guilty of CDPAP Medicaid fraud risks a variety of punishments, such as:
- Repaying Medicaid for the received benefits
- Being permanently banned from giving or receiving services in any Medicaid funded programs
- Having a professional license suspended or terminated
- Serving time in prison
- Being deported, depending on the individual’s immigration status.
Individuals who are prosecuted with Medicaid fraud in New York for amounts of over $1,000 are charged with a felony. Pleading guilty will result in having a criminal record.
Several CDPAP beneficiaries and caregivers across New York State have been charged and convicted of making fraudulent claims to Medicaid in the past few years. Here are some examples.
Stories of Medicaid Fraud
Tina Gabel and Sean Gabel
In 2016, Tina Gabel (58) and her son Sean Gabel (23) of Poughkeepsie were charged with submitting false timesheets to CDPAP fiscal intermediary AccentCare of New York.
Tina Gabel was responsible for verifying the accuracy of Sean Gabel’s timesheets. She claimed that her son provided personal assistant services to two relatives in Dutchess County between October 2011 and February 2015 while he was out of town. Medicaid paid AccentCare more than $50,000 for hours Gabel did not work.
The mother and son were arraigned in Dutchess County on felony charges of grand larceny—theft of property with a value greater than $1,000—offering a false instrument for filing, as well as falsifying business records. They pled guilty, paid restitution of $113,584, and were sentenced to five years of probation.
In 2017, Enny Portillo (58) of Highland Mills falsified timesheets submitted to CDPAP fiscal intermediary Priority Home Care Services. She claimed that her daughter provided CDPAP services in her Orange County home to Portillo’s mother who at that time was out of the country, in Colombia. Medicaid paid Priority Home Care Services more than $50,000 for hours that Portillo’s daughter did not work.
Enny Portillo was her mother’s designated representative charged with overseeing the care. She was responsible for all administrative aspects of the care, including certifying her daughter’s timesheets before they were submitted to the fiscal intermediary.
Portillo pled guilty to felony charges of grand larceny in Orange County court. She paid $75,812 in restitution and was sentenced to five years of probation, in addition to 300 hours of community service.
Ten Defendants Arrested In Home-Health Aide Fraud Scheme
In 2015, ten defendants were arrested in New York for engaging in a widespread home-health aide fraud scheme. The defendants worked at two affiliated licensed home care agencies that provide services to patients residing in all five New York City boroughs as well as Nassau County. The agencies employed approximately 3,000 home-health and personal-care aides.
A significant portion of the agencies’ billing was found to be fraudulent. They billed Medicaid for no-show cases where home-health aides provided no services to patients. At the time that they claimed to be providing care, aides stayed at home, met family and friends, ran personal errands, and went on vacation. The payment was split between the no-show aide and the no-show patients.
Each defendant was charged with one count of conspiracy to commit mail, wire, and healthcare fraud, which carries a maximum sentence of 20 years in prison, one count of mail fraud carrying a maximum sentence of 20 years in prison, one count of wire fraud carrying a maximum sentence of 20 years in prison, one count of healthcare fraud with a maximum sentence of 20 years in prison, and one count of conspiracy to violate the Anti-Kickback Statute, with a maximum sentence of 5 years in prison.
Melinda Jones and Bertha Granderson
In 2016, Melinda Jones (42) and Bertha Granderson (25), mother and daughter from Rochester, New York, were arrested for billing Medicaid for caregiving services that were never provided.
Jones served as the designated representative of her relative who was a CDPAP beneficiary, while Jones’s daughter Bertha Granderson worked as the relative’s caregiver. Jones was responsible for the administration of the relative’s care, including verifying her daughter’s timesheets.
Jones and Granderson were accused of submitting false timesheets to CDPAP fiscal intermediary Maxim Healthcare Services between September 1, 2014 and April 25, 2015. They claimed that they provided approximately 149 hours of home health care for the relative during the period when Granderson was in fact working at Sonic Restaurant or Tim Hortons. Granderson was paid $1,490 in total for the hours she did not work.
Jones and Granderson were charged with one count each of fourth-degree grand larceny, first-degree falsifying business records, as well as first-degree offering a false instrument for filing. All the charges are class E felonies.