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Pawtucket Woman Charged with Medicaid Fraud

Attorney General Peter F. Kilmartin today announced that after a two month investigation by the Rhode Island Attorney General's Medicaid Fraud and Patient Abuse Unit, Madeline Hernandez (DOB: 05/18/59), of 160 Galego Court, Pawtucket, RI, was arrested on felony charges of Medical Assistance Fraud R.I. Gen. Laws ยง40-8.2-3(a)(15).

Investigators from the Medicaid Unit spent several weeks looking into allegations that Hernandez was submitting false time sheets for providing care to an elderly family member and getting paid for those services through a Medicaid funded program for Personal Care Assistants. It is alleged that Hernandez falsely billed Medicaid at least $7,000 over a ten month period. Hernandez allegedly used another individual's identity to obtain the required approval to be employed as a personal care attendant.

The Office of Attorney General executed an arrest warrant on Tuesday, June 5, 2012. With the assistance of detectives from the Pawtucket Police Department, Hernandez was arrested and arraigned in 6th Division District Court. Bail was set at $5,000 with surety. The investigation was initiated from a referral by the Department of Human Services ("DHS").

"Fraud in home health care is the subject of many investigations throughout the country and will continue to be closely scrutinized by this office," said Attorney General Kilmartin. "With Medicaid accounting for nearly one third of the state's budget, it is inherent upon the State to ensure that each dollar is being used as intended; to provide critical services to our disabled and the elderly, some of our most vulnerable population."

Legislation, submitted by Attorney General Kilmartin, is pending before the General Assembly that would require national background checks and certification of personal care assistants in an effort to reduce this kind of fraud and to protect those who are in need of these valuable services.

H7734/S22866, sponsored by Representative Eileen Naughton and Senator Michael McCaffrey, would provide for the registration of personal care assistants. Personal care assistants provide services such as, grooming, household tasks and transportation, allowing individuals to stay in to homes longer. Currently, those seeking to be personal care assistants are subject to "state only" background checks.

"For patient safety, especially due to the vulnerability of the population, this field needs to be subject to a national background check, training and regulation. States across the country have enacted statutes and regulations for personal care services. As more patients return to the home under the Global Medicaid Waiver, we need to ensure that the most vulnerable are being treated by professional workers and protect them from victimization and exploitation," said Kilmartin.

"Unfortunately, due to the current state of the law, there is no assurance that those who fraudulently take advantage of their clients and the Medicaid system will be barred from being reemployed, which is why it is so critical that this industry be regulated, so wrongful actors can have their certification suspended or revoked. This helps ensure the safety of our seniors and disabled population as well protects our state's financial resources."

Under the Global Medicaid Waiver, the State of Rhode Island received permission from the Centers for Medicare and Medicaid to offer seniors more options. One goal was to allow them to stay in their own homes longer, and stay out of an institutional nursing home setting.

Under Attorney General Kilmartin's legislation, DHS would be the registration entity and require that every person being employed as a or offering services as a personal care assistant obtain a certificate of registration issued by the department within their initial 30 days of employment or of offering services. To receive a certification of registration, the applicant must undergo national a background check and successfully complete a basic level of training; consisting of four hours.

The legislation allows for the biannual renewal of registrations, the renewals must be granted as a matter of course with proof of completion of continuing education, two hours yearly, unless DHS finds that the registrant has acted or failed to act in a manner under the circumstances that would constitute grounds for suspension or revocation of a certificate.

Under the legislation, DHS may deny, suspend or revoke a person's certificate of registration in any case in which it finds that there has been failure to comply with the requirements under this chapter and the rules and regulations promulgated thereto or the registrant has been convicted of a disqualifying offense.

Finally, the legislation provides criminal penalties and fines for those who fraudulently serve as a personal care assistant.

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