Two members of the Anchorage medical community — a physician and a personal care agency owner — both pleaded guilty to two separate cases of Medicaid fraud, totaling to about $2.4 million in fraudulent claims.
The State of Alaska Department of Law confirms that both cases were investigated after the state was tipped off by citizens.
The state spends about $1.5 billion annually on Medicaid, said Assistant Attorney General Andrew Peterson in a phone interview.
“It’s definitely a concern when we see somebody who’s taking limited resources to line their own pockets,” he said.
Peterson adds that in the last two years alone, the state has prosecuted just under 100 criminal cases for Medicaid fraud. This, he says, is due in part to the Medicaid Fraud Control Unit expanding from three investigators to six about three years ago.
Anchorage psychiatrist pleads guilty to $1.2 million in Medicaid fraud
An Anchorage doctor at the center of a million dollar Medicaid fraud case entered a guilty plea today, according to a release from the Alaska Department of Law.
Dr. Shubhranjan Ghosh, founder of Ghosh Psychiatric Services, is accused of fraudulently billing approximately $1.2 million in Medicaid for services that were never performed and creating false medical records in attempt to cover up the Medicaid fraud, the DOL says.
Peterson says the case was brought to attention after citizen complaint.
“The way the Medicaid system works is that it’s a system, in large part, based upon trust,” Peterson said. “A case like Dr. Ghosh’s case may have gone undiscovered for years, if at all, had it not been for a citizen informant coming in and reporting the fraud.”
Multiple agencies were involved in the investigation that led to the 39-year-old’s arrest in April. Ghosh was indicted in July on 18 felony counts, including fraudulently billing Medicaid, committing a scheme to defraud Medicaid and tampering with physical evidence in an ongoing investigation. Both are felony offenses and Ghosh may see up to three and a half years in prison and a fine of up to $50,000, according to the release.
Ghosh will also be ordered to repay Medicaid for all money received, says Peterson, adding that Medicaid didn’t pay 100 percent of the approximate $1.2 million in claims. A restitution hearing will be held to determine the exact number. Ghosh will also be barred from billing Medicaid in the future.
His sentencing is scheduled for April.
$1.2 million in restitution ordered against Anchorage Medicaid care and service provider
Agnes Francisco, owner of a personal care attendant agency in Anchorage, pleaded guilty Friday to a single count of attempted medical assistance fraud.
Along with Francisco, Good Faith Services, LLC and another entity, Anchorage Adult Day Services, also entered guilty pleas.
The plea agreement calls for Good Faith, a personal care agency that provided Medicaid care and services to eligible recipients, to pay a fine of $300,000 and restitution in the amount of $1.2 million dollars, according to the DOL release. Anchorage Adult Day Services, charged with medical assistance fraud, will pay a fine of $20,000 and will be permanently suspended from providing Medicaid services.
In the case of Good Faith Services, a Medicaid recipient brought an allegation of potential fraud to the state’s attention, says Peterson.
Since the initial investigation in July 2013, the state has filed criminal chargers on 53 individuals associated with Good Faith, including over one dozen office employees that worked within the agency.
Investigation revealed that full-time office employees at Good Faith and Anchorage Adult Day Services were billing Medicaid for services before the individual employees had their background checks verified.
“Part of what this company was doing was putting people in positions of trust and employing them and paying them for services that they were allegedly performing well in advance of their background check clearing,” Peterson said.
Francisco’s sentencing is scheduled for March.