Grand Jury Indicts Haverhill Woman on Medicaid Fraud Charges

Attorney General Maura Healey.

A Haverhill woman is among five people across the state charged with allegedly defrauding the state’s Medicaid program of more than $230,000 by falsely billing for services not rendered and double billing in a number of different cases, Attorney General Maura Healey said today.

Personal care attendant surrogate Crystal Clark, 36, of Haverhill, was indicted by an Essex County Grand Jury Feb. 11, alleging she submitted fraudulent timesheets. Authorities allege that she billed MassHealth more than $64,000 for services that were not provided.

“MassHealth provides critical healthcare services for people who otherwise cannot afford them,” said Healey. “We allege that these individuals exploited this system and defrauded taxpayers, while at the same time diverting resources from those in need.”

Clark served as the PCA surrogate for her disabled son and allegedly submitted timesheets certifying that more than 4,000 hours of PCA services were provided to him by Clark’s eldest son, boyfriend and brother between January, 2010, and November, 2015.

The investigation revealed, during these times, the PCAs identified on the timesheets were often working elsewhere and could not have been providing PCA services, Healey’s office said. They allege Clark falsely represented that these services were rendered using photocopied timesheets and falsified signatures.

She was indicted on three counts of Medicaid False Claims and three counts of larceny over $250 by false pretenses. She will be arraigned in Essex Superior Court March 7.

A total of 18 indictments were returned by Plymouth, Berkshire, Essex, and Worcester County Grand Juries and are the result of criminal investigations conducted by Healey’s Medicaid Fraud Division. A criminal complaint, including charges of neglecting a disabled person, has also been issued against a PCA who will be arraigned in Boston Municipal Court on March 2.

The cases include allegations of billing MassHealth for services that were not provided, double billing for PCA and adult foster care (AFC) services, and charging for home care when a patient was hospitalized, along with several other schemes.

The attorney general’s office conducted these investigations with assistance from the Massachusetts Executive Office of Health and Human Services and the U.S. Department of Health and Human Services—Office of the Inspector General (HHS-OIG).

“We appreciate the joint effort made to identify and investigate fraudulent billing and practices that put our members’ health and safety at risk,” said Secretary of Health and Human Services, Marylou Sudders. “MassHealth is aggressively auditing and monitoring provider billing practices to ensure program integrity.”

The MassHealth PCA Program helps people with chronic or long-term disabilities live independently. The program provides funds to pay PCAs who help patients with activities of daily living while members receiving the services act as the PCA’s employer. By regulation, PCA services cannot be provided while a MassHealth member is admitted to an inpatient facility or nursing home.

MassHealth members who are unable to manage the hiring, training and firing of PCAs themselves may pick a “surrogate” to act for them (typically a family member or legal guardian). MassHealth does not allow surrogates to provide PCA services, and does not pay them to act as surrogates.

The MassHealth AFC program provides for members to receive full-time personal care and requires that the caregiver live with the member. MassHealth contracts with AFC providers to ensure members receive 24-hour direct personal care, and to provide nursing oversight and case management.

Besides Clark, individuals involved in these cases are Mary Yost, 53, of Middleborough; Frederick Phillips, 55, of Pittsfield; Scott Gibeault, 49, of Southbridge; and Tamekha Lewis-Sturrup, 29, of Dorchester.