PROVIDENCE, R.I. - Attorney General Peter F. Neronha announced that on December 3, a Providence woman was ordered to pay $84,106.25 in restitution to her former employer after being sentenced in Providence County Superior Court for Medicaid fraud charges. The charges stem from her role in a scheme to divert Medicaid funds into personal bank accounts owned and controlled by her and several co-defendants.
Giovanne Gomez (age 32), plead nolo contendere to two counts of obtaining money under false pretenses from the Rhode Island Medical Assistance Program (Medicaid).
At a hearing before Superior Court Justice Luis M. Matos, the court sentenced Gomez to six years at the Adult Correctional Institution (ACI), with one year to serve in home confinement and the balance suspended with probation. Additionally, Gomez was required to pay $84,106.25 in restitution to her former employer, with the special condition that the amount be paid in full prior to sentencing.
Four other individuals participated or are alleged to have participated in the fraud scheme, in which a total of $120,605.78 was fraudulently obtained from Medicaid.
Thomas Espinal (age 43), Gomez's husband, pleaded nolo contendere to two counts of maintaining a common nuisance and was sentenced to serve three years of probation. Anair Centio, Mariser Liranzer, and Martine Silva have all been charged with felony counts in relation to their alleged involvement in the Medicaid fraud scheme.
"The defendant here engaged in a complex, criminal scheme to defraud the Medicaid program of significant funds that are always in short supply and provide critical health care services to our state's most vulnerable residents," said Attorney General Neronha. "Identifying and preventing Medicaid fraud is a critical responsibility of this Office, and we will continue our efforts to hold accountable those who steal public funds at the expense of others."
Had the case proceeded to trial, the State was prepared to prove beyond a reasonable doubt that between January 1, 2016 and July 12, 2017, Gomez committed Medicaid fraud while employed as a manager at A Caring Experience (ACE) Nursing Services in Cranston by skimming funds into two bank accounts controlled by her and co-defendants.
As a manager at ACE, a healthcare provider to those in need of home-based services, Gomez had access to Medicaid recipients' records, including services approved and the amount of unused or unbilled hours. Gomez used that access to information of approximately 100 Medicaid recipients to create fraudulent timesheets in the names of over 30 Certified Nursing Assistants, who were past or present employees of ACE, for services that were never provided. The fabricated timesheets were submitted for payment to Rhode Island Medicaid and were paid by direct deposit into accounts owned and controlled by Gomez and her co-defendants.
Two of the bank accounts where Medicaid funds were directed belonged to a business owned by Espinal. Gomez and Espinal jointly made cash withdrawals, tendered checks, or made wire transfers from the funds diverted into those bank accounts.
In March 2017, ACE reported the suspected Medicaid fraud to the Office of the Attorney General.
Investigator William Magill of the Attorney General's Medicaid Fraud Control and Patient Abuse Unit and investigators with the Rhode Island Department of Health and Human Services, Office of Inspector General, Office of Investigations led the investigation into the case.
Special Assistant Attorney General Kimberly Brissette Brown of the Medicaid Fraud Control and Patient Abuse Unit prosecuted the case on behalf of the Office of the Attorney General.