N.J. A.G. Platkin: Caregiver Found Guilty of Defrauding Medicaid of Roughly $45K by Billing for Caretaking Services in New Jersey While Working at Her Teaching Job in Michigan

TRENTON, New Jersey, Nov. 16 -- New Jersey Attorney General Matthew J. Platkin issued the following news release on Nov. 15, 2023:

Attorney General Matthew J. Platkin and the Office of the Insurance Fraud Prosecutor announced today that a Michigan woman was found guilty after trial of defrauding the New Jersey Medicaid Program. The guilty verdict came after a four-day jury trial in Morris County before Superior Court Judge Claudia Jones.

Michael Ann Ellis, 62, of Flint, Michigan, was found guilty of all counts of health care claims fraud (2nd degree), Medicaid fraud (3rd degree), and theft by deception (3rd degree). Ellis is detained pending sentencing, facing up to 10 years in New Jersey State Prison and a fine of up to $150,000.

The jury heard testimony that Ellis was the designated caregiver for her ex-boyfriend, who suffered a stroke and required care. In that capacity, she submitted fraudulent timesheets between January 5, 2016, and April 13, 2020, and was compensated by the New Jersey Medicaid Program for caretaking services she never rendered. The case began with a referral to the Office of the Insurance Fraud Prosecutor - Medicaid Fraud Control Unit (OIFP-MFCU) in June 2020 from Morris County Adult Protective Services (APS).

The investigation revealed Ellis was paid by Medicaid, as part of the Personal Preference Program, to provide up to 56 hours of care per week to her ex-boyfriend. However, the jury heard testimony that Ellis was employed as a substitute teacher in Michigan, and she was working in the teaching position on the same dates she was billing for services rendered in New Jersey. This was corroborated by witness testimony from a superintendent from one of the Michigan schools, along with timesheets and payroll records with school locations, dates, and hours of substitute teaching duties Ellis performed in Michigan. Further, Ellis' bank records showed numerous transactions taking place in Michigan, on or around the same dates Ellis was substitute teaching.

As evidenced by the jury's verdict, it was clear from the evidence that on the same dates Ellis was substitute teaching in Michigan, she was submitting timesheets for reimbursement to Medicaid for care she never rendered in New Jersey. Ellis submitted fraudulent timesheets for 361 dates of service between January 6, 2016, and April 13, 2020, (roughly 3,227 hours), and was paid approximately $45,000 by the Medicaid Program, for services never rendered. The State is seeking restitution at the time of sentencing.

"Flagrant abuse of programs available through Medicaid, like the Personal Preference Program, that were developed to support our citizens in need of care, will not be tolerated," said Attorney General Platkin. "The defendant thought she could get away with billing for care in New Jersey when she was in another state. If you think you are not going to get caught, you are wrong."

"Our detectives and attorneys did an excellent job of uncovering and prosecuting this fraud. We have the tools and talent to hold those committing fraud accountable, as evidenced by this conviction, and we will continue to tirelessly protect the Medicaid Program from abuse," said Interim Insurance Fraud Prosecutor Al Garcia.

Deputy Attorneys General (DAsG) Lauren Aranguren and Vladimir D'Argenio prosecuted the case for the OIFP - MFCU, under the supervision of Assistant Bureau Chief Michael Klein and Bureau Chief Heather Hadley. Sgt. Danielle Han led the investigation and Detective Chantel Blake assisted the DAsG as the trial detective, under the supervision of Deputy Chief Rich King.

New Jersey MFCU's total funding for federal fiscal year (FY) 2023 is $9,418,641. Of that total, 75 percent, or $7,063,984, is awarded under a grant from the U.S. Department of Health and Human Services. The remaining 25 percent, totaling $2,354,657 for FY 2023, is funded by the State of New Jersey.

OIFP's Medicaid Fraud Control Unit specifically protects Medicaid beneficiaries and the Medicaid Program from fraud, waste, and abuse. Further, the Unit may review complaints of abuse or neglect of patients or residents in care facilities regardless of the funding source. To report fraud, abuse or neglect, please email [email protected] or call 609-292-1272. If you are concerned about insurance cheating in general, and have information about insurance fraud, you can report fraud anonymously by calling the toll-free hotline at 1-877-55-FRAUD, or visiting www.NJInsurancefraud.org. State regulations permit a reward to be paid to eligible persons who provide information that leads to an arrest, prosecution, and conviction for insurance fraud.

Insurance Fraud - Report It. End It.

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Defense Attorneys:

Caroline Kelble, Esq., Office of the Public Defender

Maureen Miller, Esq., Office of the Public Defender

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Original text here: https://www.njoag.gov/caregiver-found-guilty-of-defrauding-medicaid-of-roughly-45k-by-billing-for-caretaking-services-in-new-jersey-while-working-at-her-teaching-job-in-michigan/