Middleborough WOMAN Pleads Guilty, SENTENCED FOR Defrauding State’s Medicaid Program

Middleborough WOMAN Pleads Guilty, SENTENCED FOR Defrauding State’s Medicaid Program Defendant Pleaded Guilty to Medicaid Fraud and Larceny

PLYMOUTH – A Middleborough woman has pleaded guilty and been sentenced in connection with making duplicative claims for personal care services, causing an overpayment of more than $140,000 from the state’s Medicaid Program (MassHealth), Attorney General Maura Healey announced today.

Mary Yost, age 54, pleaded guilty on Friday in Plymouth Superior Court to charges of Medicaid Fraud and Larceny over $250 by False Pretenses. After the plea was entered, Superior Court Judge Angel Kelley Brown sentenced Yost to five years of probation. Yost was also ordered to pay restitution and is prohibited from receiving or causing payment of MassHealth funds.

Yost was indicted in February 2016 after an investigation by the AG’s Office revealed that between May 2009 and April 2014, she double-billed MassHealth for more than $140,000 by billing for Personal Care Attendant (PCA) and Adult Foster Care (AFC), more than $80,000 of which was paid directly to her.

The AG’s Office began an investigation upon a referral from MassHealth after they received information that Yost was both a PCA surrogate and AFC caretaker for a member and purposely participated in both the PCA program and the AFC program, in violation of MassHealth regulations.

Yost also submitted timesheets reflecting that another individual provided PCA services to the member between June 2011 and April 2014. The investigation revealed that the individual reflected on the timesheets was working elsewhere or in college for some of these time periods so could not have provided the services.

The MassHealth PCA Program helps people with chronic conditions or long-term disabilities live independently. The program provides funds to pay PCAs who help patients with activities of daily living while members receiving the services act as the PCA’s employer.

MassHealth members who are unable to manage the hiring, training and firing of PCAs themselves may pick a “surrogate” to act for them (typically a family member or legal guardian). MassHealth does not allow surrogates to provide PCA services, and does not pay them to act as surrogates. 

The MassHealth AFC program provides for members to receive full-time personal care and requires that the caregiver live with the member. MassHealth contracts with AFC providers to ensure that members receive 24-hour direct personal care, and to provide nursing oversight and case management.

Under AFC regulation, MassHealth will not pay for AFC services if a member is receiving PCA services at the same time. 

Assistant Attorney General Evelyn Y. Tang of Attorney General Maura Healey’s Medicaid Fraud Division handled this case, which was investigated by Investigators April Waterhouse and Michael Russo, also of the Medicaid Fraud Division. The Boston office of the U.S. Department of Health and Human Services Office of Inspector General assisted with the investigation along with the State Auditor’s Office.