CT man gets 15 months for defrauding Medicaid of $909,000, mostly through unlicensed counseling [Journal Inquirer, Manchester, Conn.]

Apr. 17—HARTFORD — A man convicted of defrauding the Medicaid medical assistance program for the poor of some $909,000, mostly by billing for counseling by unlicensed people, was sentenced Wednesday to 15 months in prison, the state Division of Criminal Justice announced.

Ramon Apellaniz, 39, who has listed addresses in East Hartford and Middletown, had pleaded no contest in September to first-degree larceny, health insurance fraud and first-degree identity theft.

A no-contest plea is not an admission of guilt but leads to a conviction.

Judge David P. Gold, who imposed the sentence Wednesday in state Superior Court in Hartford, ordered Apellaniz to spend five years on probation after he is released from prison, with the possibility of up to six years and nine months more behind bars if he were to violate release conditions.

Apellaniz has paid $156,000 in restitution for the losses his frauds caused the state and federal governments, which fund Medicaid jointly, according to a Division of Criminal Justice statement.

He was ordered to repay the remaining total of more than $753,000 during his probation, according to the statement.

Apellaniz "was listed as the sole principal of the Gemini Project LLC., a Newington business that offered counseling to numerous patients with mental, behavioral and emotional disorders, but employed only one professional who was actually licensed to do so," the DCJ statement said.

The bulk of the fraudulent bills Apellaniz submitted to Medicaid were for services provided by unlicensed people, which totaled more than $909,000, according to an affidavit by Inspector Thomas Steck of the chief state's attorney's office. Apellaniz saw patients though he was not licensed as a counselor, and other Gemini Project employees did the same, authorities said.

The identity theft conviction stemmed from the use of a licensed professional's identity to submit fraudulent claims, according to the DCJ statement.

Steck quoted a former Gemini Project employee as saying that he became suspicious when the company's sole licensed counselor was ordering merchandise and Apellaniz told him to leave Apellaniz's name off the paperwork.

The employee said he had asked a professor at his college whether a licensed counselor could supervise unlicensed clinicians and was told via email that this could be done only in a clinic, not in a private practice, according to the inspector.

The employee said that when he reported what he had learned to Apellaniz and showed him a copy of the email, Apellaniz replied that the Gemini Project was no longer a private practice but was a small business that could have unlicensed people provide therapy, the inspector reported.

The employee also said Apellaniz offered him 50 percent of the business, which the employee said he declined, according to the inspector.

Apellaniz's lawyer, Anthony Spinella, on Wednesday called the sentence "a fair disposition given the quantity of money that was taken." He said much of the money went to pay Apellaniz's employees.

Apellaniz has another case pending in state Superior Court in Middletown in which he is charged with first-degree larceny, a related conspiracy count and two counts of second-degree forgery, online court records show. He has pleaded not guilty to those charges.

Spinella also represents him in that case and said he expects a resolution in which Apellaniz will get a concurrent sentence that won't add to his time in prison.

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