Sign in Subscribe
Fraud

Massachusetts Attorney General Secures Guilty Plea in Widespread Home Health Fraud Scheme

Strategic Insights

— 2 min read

Attorney General Andrea Joy Campbell announced that 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. Mercedes was sentenced to 1-3 years in state prison, 5 years of probation, and ordered to pay $500,000 in restitution to the Commonwealth.

Key Takeaways:

  • The fraud scheme targeted vulnerable community members in the Worcester area, including homeless, elderly, and disabled individuals, and biller them for false home health services through MassHealth's Personal Care Attendant (PCA), Home Health Aide (HHA), and Adult Foster Care (AFC) programs.
  • Mercedes and his co-conspirators falsely billed for at least seventeen different MassHealth members, causing many of those members not to receive critical, medically necessary health services.
  • The scheme utilized MassHealth funds for personal expenses, including travel, lifestyle, jewelry, and various luxury items, totaling over $500,000 in false claims.
  • Mercedes was barred from any responsibilities related to the MassHealth program and from working with the elderly or disabled.
  • This matter is representative of the AGO's commitment to combatting MassHealth fraud, including fraud of MassHealth's PCA program.
  • In related cases, a Randolph personal care attendant pleaded guilty to defrauding the PCA program and was sentenced to 18 months in jail, while a personal care attendant pleaded guilty to defrauding the PCA program and was sentenced to one year in state prison and ordered to pay restitution.
  • A former South Deerfield resident pleaded guilty to defrauding the PCA program and was sentenced to two years in the House of Correction, suspended for two years.

Statistics:

  • Over $500,000 in false claims were billed by Mercedes and his co-conspirators through MassHealth's PCA, HHA, and AFC programs.
  • Seventeen MassHealth members were affected by the scheme, with many denied critical, medically necessary health services.
  • Mercedes was sentenced to 1-3 years in state prison, 5 years of probation, and ordered to pay $500,000 in restitution to the Commonwealth.
  • The AGO's Medicaid Fraud Division receives 75 percent 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 percent, totaling $1,974,102 for FY 2025, is funded by the Commonwealth of Massachusetts.

Sources:

  • Office of the Attorney General
  • https://www.mass.gov/news/ag-campbell-secures-guilty-plea-from-ringleader-of-worcester-based-home-health-fraud-scheme-exploiting-vulnerable-residents

Read more