Unlicensed CT counselor sentenced to prison, ordered to pay $900K for role in Medicaid fraud scheme [Hartford Courant]

An East Hartford man has been sentenced to 15 months in prison and ordered to pay more than $900,000 in restitution for defrauding the Medicaid program by submitting claims for counseling services that were done by someone who was unlicensed or never provided at all.

Ramon Apellaniz, 39, faced sentencing Wednesday in Hartford Superior Court, where Judge David P. Gold ordered that he serve five years of probation once he is released from prison, according to the Connecticut Division of Criminal Justice. While on probation, a violation would expose Apellaniz to an additional six years and nine months in prison, Gold ordered.

Gold also ordered Apellaniz to pay $753,269 in restitution on top of the $156,000 he has already paid, according to criminal justice officials.

On Sept. 12, Apellaniz pleaded no contest to felony charges of first-degree larceny by defrauding a public community, health insurance fraud and first-degree identity theft.

According to criminal justice officials, an investigation by the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney found that Apellaniz was listed as the sole principal of Gemini Project, LLC. in Newington, which offered counseling services for patients with mental, behavioral and emotional disorders. Apellaniz was not licensed to provide counseling services, though Gemini employed one person who was licensed.

Judicial officials said Medicaid Fraud Control Unit Inspectors discovered that 9,717 of the 12,771 claims submitted by Gemini Project between January 2018 and July 2019 were for services provided by unlicensed persons, including Apellaniz.

A total of 462 claims were submitted for services that were not delivered at all, according to officials.

To submit the fraudulent claims and obtain $909,269 in fraudulent billings, Apellaniz used the provider number of a licensed provider without their knowledge, investigators found.

Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Medicaid Fraud Control Unit at the Office of the Chief State’s Attorney at 860- 258-5986.

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