Three Holyoke Residents Sentenced For Defrauding Masshealth

BOSTON – Three Holyoke residents were sentenced this week in U.S. District Court in Springfield for defrauding MassHealth, the Commonwealth’s Medicaid program.

Today, Aida Hernandez, 59, was sentenced to two years of probation and ordered to pay $23,383 in restitution. On Jan. 15, 2013, Maria Jusino, 35, was sentenced to three years of probation, including six months of home confinement, and ordered to pay $159,285 in restitution to MassHealth. Rafael Belen, 39, was also sentenced to time served, to be followed by three years of supervised release, during which time he will be required to perform 100 hours of community service, and ordered to pay $78,956 in restitution. In August 2012, Jusino, Belen and Hernandez pleaded guilty to conspiracy to commit health care fraud.

Beginning in 2006 and continuing through 2011, the three co-conspirators engaged in a scheme to defraud the state’s Personal Care Attendant (PCA) Program. The PCA Program, funded by MassHealth, the Commonwealth’s Medicaid Program, helps individuals with permanent or chronic disabilities keep their independence, stay in the community, and manage their own personal care. The defendants caused MassHealth to be billed for services that were never provided. For example, Jusino billed MassHealth for PCA services she claimed she provided to two different individuals at the same time. Other examples include the following:

• Jusino and Belen signed times sheets for PCA services for their son that were never provided;
• Belen claimed to be providing for PCA services to his brother-in-law in Holyoke when Belen was, in actuality, on vacation in Puerto Rico;
• Hernandez signed time sheets for PCA services she claimed she was provided to Jusino’s son on the same dates and during the same hours that she was running a day care center in her home; and
• Jusino billed MassHealth for PCA services she claimed she was performing for her mother during the same hours that Hernandez was billing MassHealth for PCA services she claimed to be providing to Jusino.

United States Attorney Carmen M. Ortiz and Susan J. Waddell, Special Agent in Charge of the Department of Health and Human Services, Office of Inspector General, Office of Investigations, made the announcement today. The case was investigated by the U.S. Department of Health and Human Services with the assistance of the Commonwealth of Massachusetts Auditor’s Office, Bureau of Special Investigations and the Commonwealth of Massachusetts, Office of the Attorney General, Medicaid Fraud Division. The case was prosecuted by Assistant U.S. Attorney Karen L. Goodwin of Ortiz’s Springfield Office.