OMG - how widespread it this?
[quote]Moved to America, got citizenship, defrauded State of Alaska of Medicaid dollars
AND THEN THERE’S THE BOOZE, METH, AND A STOLEN $364,756
Victor Aldeza, Regino Aldeza, and Albert Aldeza were keeping their lucrative crime business in the family for nearly a decade.
For years, they defrauded the Alaska Medicaid program of $364,756.70, by having one of them fake a disability so they could all mooch off the government.
They barely even tried to hide their scheme and the judge who sentenced them today said they showed no sign of stopping.
There were numerous counts against the Aldezas since their arrest in 2017, but in the end, the State accepted pleas for some of the felony counts, let them plead out on others, and they were sentenced today, ending the saga.
The irony is that once they start serving their prison time, they’ll have all their medical needs covered by the State of Alaska during their incarceration. If they need medical care outside the prison, that will be covered by … wait for it … Medicaid.
HOW THEY DID IT
The case is a textbook example of how Medicaid fraud occurs. It involves personal care assistants who are providing in-home care and being reimbursed by U.S. taxpayers through the Medicaid program.
The Alaska Medicaid program, as in most states, pays for PCA agencies to provide care to seniors or disabled people enrolled in Medicaid, and this allows the medically vulnerable person to remain in their own home rather than be placed in a long-term care facility.
A contract is worked out between the Department of Health and Social Services and the PCA agency to determine the number of hours and the exact sort of care the client needs, such as feeding, helping them use the toilet, bathing, and other daily needs.
Medicaid pays approximately $24 an hour to the PCA agency and the agency must pay the actual care provider at least half of that amount. Often, that provider is a member of the family.
This Alveda crime syndicate case involved various types of Medicaid fraud.
Travel billing fraud: When Medicaid is billed for services that could not have been provided because the provider or recipient was traveling out of country at the time for which the services were billed.
Faking health condition: This type of fraud is called malingering and it’s when a client exaggerates or fakes their health condition, and then colludes with the PDA agency or health care provider to continue billing for services that are not needed.
Time sheet fraud: Billing for services that could not have occurred when they said they occurred.
Arctic Care Services provides oversight for such PCA services. On March 18, 2017, an employee of Arctic Care Services was in the Dimond Mall food court in Anchorage, when he recognized Regino Aldeza working at the Charley’s Philly Steaks fast food restaurant.
That was odd, because Regino was listed as significantly disabled, a Medicaid recipient being taken care of by his personal care assistant, Victor Aldeza, who was employed by Arctic Care Services.
And yet, the Arctic Care Services worker observed Regino working normally and without any physical strain at the fast-food restaurant.
The records show that the Aldeza family was billing Medicaid for nearly full-time care — about 36.5 hours per week in assisting Regino with all aspects of his life — eating, locomotion, toileting, meal preparation, basic household chores, basic walking, and range of motion exercises, and personal hygiene.
Victor Aldeza, Regino Aldeza, and two powers of attorney George Aldeza and Alberto Aldeza had convinced Arctic Care and DHSS that Regino needed that full-time health care, including “six mobility transfers, eight locomotion events, two dressing events, three eating events, eight meal preps (seven ‘light’ meals and one ‘main’ meal), six toilet uses, one personal hygiene, one ‘shopping’ event, and two vital sign checkups.”
Victor, George, Albert and their sister were billing all or nearly all of these services every day for years by submitting time sheets to Arctic Care, saying services had been performed for Regino. In his weekly case notes, Victor was supposed to indicate if there was any improvements or declining Regino’s health. He always wrote no, no change for better or worse.
And yet, there was Reginoonce again on March 21, 2017, working hard a the mall, moving heavy objects, conversing normally, using the cash register to make change, preparing meals quickly in a fast-food environment. He was driving to and from work, and walking to and from his car. He was changing into and out of his uniform.
There was nothing wrong with Regino Aldeza.
Well, except the alcohol and meth problem, and the domestic violence charges and violating conditions of release resulting from that episode. He was in and out of jail a bit, but the bills kept on coming.
A search warrant into Regino’s medical records showed that he had, indeed, developed a single canker sore, and had dizzy spells after he took up smoking meth. He had the occasional bout of gout and headaches. He had a several-week episode of going to the emergency room for various maladies related to meth. Yes, he had a history of an aneurysm but no medical professional had noted a disabling medical condition. His last followup for his aneurysm was in 2008.
On March 29, 2017, the Medicaid Fraud Unit assigned the case and the investigator reviewed and confirmed that Regino had worked at fast food restaurants since 2015, and had worked at Wrightway Auto Carriers in 2012. Regino had obtained a fishing and hunting license for years, received a speeding ticket in 2012 in Kenai, and had been arrested for assault. He lost his passport because he was delinquent on his child support.
The investigator also found that while Victor was billing for taking care of Regino, Victor was at times out of the country, or was billing for times when Regino was working away at his fast-food job, as shown on Dimond Mall surveillance video, or when he was in the custody of the Department of Corrections.
The entire fraud timeline took place between 2009 and 2017, when the long arm of the law caught up with the Aldezas.
The three defendants entered pleas to felony fraud and theft counts. On Thursday, Judge Catherine Easter sentenced Victor and Regino Aldeza to identical sentences of five years with two and half years suspended, probation five years. She sentenced Albert Aldeza to four years, with two suspended, probation five years. All were ordered to reimburse the state Medicaid program $364,000 in restitution.
Assistant Attorney General Eric Senta argued that the Aldezas’ scheme victimized a state program with extremely limited funding, stealing money intended to pay for disabled children’s wheelchairs and compassionate end-of-life care for the state’s sick and elderly.
The defendants, from the Philippines originally, have significant ties out of the country. Regino immigrated to the U.S. in 1985, and became a citizen in 2008, George immigrated around 2016, and Victor Aldeza routinely travels out of the country. All listed the same residence on their drivers licenses — a home owned by Victor.
Judge Easter stated that the defendants had been signing fraudulent documents at least twice a month for years and if not for an alert case worker who tipped off the state’s Medicaid Fraud Unit, the fraud would have continued indefinitely, a fraud that she said was motivated by pure greed./quote]
