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Two Attleboro Residents Charged with Medicaid Fraud

Attorney General Peter F. Kilmartin today announced that the Office has charged Galinda Daniels (DOB: 05/14/1974), and Bertha Daniels (DOB: 05/30/1978), both with a last known address of 54 Roberts St., Attleboro, MA, each with three counts of Medicaid Fraud.

After an investigation by the Attorney General's Medicaid Fraud Control Unit, it is alleged that between November 24, 2012 and January 1, 2013, Galinda Daniels and Bertha Daniels each submitted fraudulent payment claims to the state's Medicaid system for personal care attendant services they did not perform, totaling $5,712. Through the course of the investigation, the state determined the patient for whom they were billing the state for personal care attendant services was hospitalized.

Recognizing that individuals need different levels of care at home, the home health care system, established through the Global Medicaid Waiver, relies on the expanded use of personal care assistants. Personal care assistants do not provide any medical services, but do provide services to help consumers stay in their home, such as grooming, household tasks and transportation, and are funded by the state's Medicaid program.

Under current law, there is no formal licensing procedure for those who work as personal care attendants and rare paid by the state's Medicaid program. In addition, Personal care attendants are not required to undergo a national background check.

To combat Medicaid fraud and to protect those individuals who rely on personal care attendants, Attorney General Peter F. Kilmartin has filed legislation that would require national background checks and a licensing program for all people who serve as personal care attendants.

"Personal care attendants provide vital services for patients who want to stay in their own homes, helping them maintain their independence while ensuring their safety and well-being. However, especially as the home care field continues to expand, it is imperative that we regulate businesses and workers in this field," said Kilmartin.

The legislation (H5538/S0461), sponsored by Representative Eileen Naughton and Senator Michael McCaffrey, would require that all personal care assistants to be subject to a national background check as a condition of certification and employment. It also requires that personal care attendants obtain a certificate of registration issued by the Department of Health (HEALTH), and proper training. Additionally, it allows for the biannual renewal of registrations, which would be granted as a matter of course with proof of completion of continuing education unless HEALTH finds that the registrant has acted or failed to act in a manner that would constitute grounds for suspension or revocation of a certificate.

The legislation allows for HEALTH to 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, or that 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.

"From my viewpoint, this is a safety issue for our most vulnerable citizens, as well as a fiscal issue for taxpayers. Medicaid fraud units across the country estimate that more than 50 percent of reported Medicaid fraud cases involve home care services, yet in Rhode Island, home care Medicaid fraud accounts for only one to two percent of our Medicaid Fraud Unit's case load," added Kilmartin. "While it would be optimistic to say that Rhode Island has such a low percentage of Medicaid fraud attributed to home care services because these criminal acts are not occurring, it is likely due to the fact that personal care attendants are not aptly regulated. Therefore, there is not an adequate process to determine whether fraud is taking place."

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