Massachusetts Attorney General Announces Guilty Plea in MassHealth Fraud Scheme

Strategic Insights -

Attorney General Andrea Joy Campbell announced today that Felix Mercedes, 35, of Worcester, has pleaded guilty to orchestrating a widespread MassHealth fraud scheme involving the stealing of personal information from disabled, elderly, and unhoused individuals to bill for false home health services in the Worcester area. The scheme, which began in 2019, involved Mercedes and his co-conspirators billing MassHealth over $500,000 for home health services that were never provided.

According to the Attorney General's Office, Mercedes targeted vulnerable community members in the Worcester area, including homeless, elderly, and disabled individuals, and would often invite victims to stay in his home. Mercedes then fraudulently used their personal information to sign them up for MassHealth services, including PCA and other home health services, often without their knowledge or consent. The AGO alleged that Mercedes and his co-conspirators utilized the MassHealth funds for personal expenses, including travel, lifestyle, jewelry, and various luxury items, including from brands such as Gucci and Coach, and a downpayment on a home in Worcester.

Key Takeaways:

  • Felix Mercedes, 35, of Worcester, pleaded guilty to orchestrating a widespread MassHealth fraud scheme involving the stealing of personal information from disabled, elderly, and unhoused individuals to bill for false home health services in the Worcester area.
  • Mercedes and his co-conspirators billed MassHealth over $500,000 for home health services that were never provided.
  • The scheme involved Mercedes targeting vulnerable community members in the Worcester area, including homeless, elderly, and disabled individuals, and using their personal information to sign them up for MassHealth services without their knowledge or consent.
  • Mercedes and his co-conspirators utilized the MassHealth funds for personal expenses, including travel, lifestyle, jewelry, and various luxury items.
  • The Massachusetts Medicaid Fraud Division is a federally certified unit that investigates and prosecutes health care providers who defraud the state's Medicaid program, MassHealth.
  • The division receives 75% of its funding from the U.S. Department of Health and Human Services and 25% from the Commonwealth of Massachusetts.

Statistics:

  • MassHealth was billed over $500,000 for home health services that were never provided.
  • Mercedes and his co-conspirators utilized the MassHealth funds for personal expenses, including:

+ Travel

+ Lifestyle purchases

+ Jewelry

+ Various luxury items, including from brands such as Gucci and Coach

+ A downpayment on a home in Worcester

  • The Massachusetts Medicaid Fraud Division receives 75% of its funding from the U.S. Department of Health and Human Services under a grant award totaling $5,922,320 for federal fiscal year 2025.
  • The remaining 25% of the division's funding, totaling $1,974,102 for FY 2025, is funded by the Commonwealth of Massachusetts.

Sources:

  • Office of the Governor of Massachusetts
  • Attorney General's Office (AGO)
  • MassHealth
  • U.S. Department of Health and Human Services
  • Office of the Inspector General for the U.S. Department of Health and Human Services
  • Office of the State Auditor's Bureau of Special Investigations
  • Social Security Administration's Office of Inspector General
  • Massachusetts State Police
  • Worcester Police Department's Special Crimes Unit
  • Office of the Attorney General's Medicaid Fraud Division