Highlight on Alaska: ‘Good Faith’ Medicaid Fraud Guilty Plea

An ongoing federal and state criminal investigation led to guilty pleas from three individuals and entities involved in a far-reaching scheme to defraud Medicaid, according to the Alaska Department of Law’s Medicaid Fraud Control Unit (MFCU).

Background

Good Faith Services, LLC (Good Faith), was an Anchorage personal care agency. Good Faith provided eligible Medicaid recipients with personal care, transportation, and care coordination services. A citizen complaint was filed against Good Faith, which led to a joint investigation by MFCU, the Alaska Department of Health and Social Services, the HHS Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and Immigration and Customs Enforcement (ICE). The investigation revealed that 10 full-time Good Faith office employees billed Medicaid almost $400,000 for services they claimed to be providing while simultaneously working in the office; MFCU also alleges that Good Faith fraudulently billed Medicaid for more than $1 million in services provided in violation of Alaska Administrative Regulations by PCAs who had not yet received a valid background check.

In July 2013, 25 Anchorage-based personal care attendants (PCAs) and Medicaid recipients, all of whom were associated with Good Faith, were charged with criminal medical assistance fraud. An additional 53 individuals associated with Good Faith, including 13 of the company’s 16 office staff employees, have also been charged with criminal medical assistance fraud.

Plea Deals

On November 28, 2014, Good Faith pleaded guilty to a single count of medical assistance fraud, which is a class B felony. At the same time, one of Good Faith’s owners, Agnes Francisco, entered a guilty plea to a single count of attempted medical assistance fraud, a class C felony and a related entity, and Anchorage Adult Day Services entered a plea of guilty to a single count of class B misdemeanor medical assistance fraud.

Under its plea agreement, Good Faith will be required to pay a fine of $300,000 and restitution of $1.2 million. Further, Good Faith must permanently dissolve as a corporate entity and provide a declaration to the OIG that it will no longer provide Medicaid services. This follows the state suspending Good Faith’s billing privileges in November 2013. Anchorage Adult Day Services will pay a fine of $20,000 and is permanently suspended from providing Medicaid services.

Francisco, 55, will be sentenced by the court on March 31, 2015. Under the terms of her plea agreement, the court must find that Francisco’s conduct was designed to obtain a substantial pecuniary gain with a low risk of prosecution and punishment, which is an aggravating feature allowing the court to impose a longer period of incarceration. The presumptive range is zero to two years; with the aggravator, Francisco faces up to five years. She may also be fined up to $50,000.