4 from Worcester indicted in Medicaid fraud scheme

• Posted by Worcester News April 2, 2024 - Filed in News - #Worcester  #Mass. Attorney General  #Worcester County Superior Court  - 7,720 views

  More than $500K went for travel, jewelry and a down payment on a house in Worcester, officials say

  
  LEONARDO DASILVA, CC BY 3.0, via Wikimedia Commons

  BOSTON — In a significant crackdown on Medicaid fraud, Mass. Attorney General Andrea Joy Campbell announced the indictment of 4 individuals from Worcester involved in a scheme allegedly exploiting the MassHealth system. The indictments were issued in Worcester County Superior Court, uncovering a fraudulent operation where over $500,000 in false claims were made for home health services that were never provided.

  The individuals, Felix Mercedes, Elizabeth Betances Rosario, Yaneris Mercedes De Rivera, and Yenifer Barrera, all from Worcester, faced charges for their roles in fabricating claims related to personal care attendant services, home health aides, and Adult Foster Care caretaking.

  The indictments allege that on multiple occasions since at least 2019, Felix Mercedes, with assistance from his co-conspirators, fraudulently billed MassHealth for home health services that were not provided. The AG’s Office alleges that Mercedes targeted vulnerable community members, including homeless and disabled individuals, for the scheme, often inviting them to stay in his home. Mercedes then allegedly used the personal information of the victims to sign them up for MassHealth services, including PCA and other home health services, often without their knowledge or consent. The home health services were then billed to MassHealth, despite never being provided.

  Mercedes and his co-conspirators allegedly utilized the MassHealth funds for personal expenses, including travel, lifestyle, jewelry, and various luxury items, along with a down payment on a home in Worcester.

  Felix Mercedes faces a string of charges, including Medicaid false claims, larceny over $1,200, identity fraud, conspiracy, witness intimidation and money laundering. Held on $25,000 cash bail, Mercedes is barred from working in healthcare or with vulnerable populations during the legal process.

  His co-conspirators, charged with Medicaid false claims and larceny, are released on bail with similar restrictions, emphasizing the seriousness of the allegations against them. These indictments are the culmination of a collaborative investigation involving the Attorney General's Medicaid Fraud Division, the U.S. Department of Health and Human Services' Office of Inspector General, and local law enforcement.

  "The exploitation of vulnerable individuals to defraud public health care is unacceptable," stated AG Campbell. "Our office remains dedicated to holding such offenders accountable, safeguarding critical health care services for Massachusetts residents."

  “The Worcester Police Department Special Crimes Unit works tirelessly to defend vulnerable populations that are often defenseless. This collaborative long-term investigation with the Worcester Police Special Crimes Unit, Attorney General’s Office, and the U.S. Department of Health and Human Services Office of Inspector General is another great example of the dedication and professionalism needed to serve the most susceptible of our populations and protect them from these kinds of crimes,” said the Worcester Police Department.

  This case highlights the ongoing challenges and measures in place to combat fraud within public healthcare systems, ensuring that resources reach those in need. The MassHealth PCA program, among others implicated in this scheme, is designed to support individuals with chronic or long-term disabilities, emphasizing the impact of such fraudulent activities on community well-being.