FWA (MA)- Two Individuals Charged With Defrauding MassHealth by Billing for Services Not Provided

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[MM Curator Summary]: Parisella and Martel used false time sheets for personal care attendant and applied behavioral therapy services to the same relative.


Clipped from: https://www.mass.gov/news/two-individuals-charged-with-defrauding-masshealth-by-billing-for-services-not-provided

SALEM — Two individuals have been charged in connection with a scheme to fraudulently bill MassHealth, the state Medicaid program, for personal care attendant (PCA) and applied behavioral analysis (ABA) services that were never provided, Attorney General Maura Healey announced today.

Jessica Parisella, 42, of Danvers, was indicted Monday by an Essex County Grand Jury on charges of Medicaid False Claims and Larceny over $1,200. Board Certified Behavior Analyst and Licensed Mental Health Counselor Donald Martel, 67, of Georgetown, was also indicted on charges of Medicaid False Claims and Larceny over $1,200. The two defendants are set to be arraigned on January 24 in Essex Superior Court.

The MassHealth PCA program helps people with chronic or long-term disabilities live independently in the community by providing medically necessary physical assistance with personal care needs. Through the consumer-driven MassHealth PCA program, eligible MassHealth members employ PCAs to assist them with their activities of daily living. These services are paid for by MassHealth through a fiscal intermediary.

ABA services are prescribed therapies provided to people with Autism Spectrum Disorder. MassHealth covers ABA therapy to children under age 21; the treatments include professional, counseling, and guidance services that are necessary to develop, maintain, and restore, to the maximum extent practicable, the functioning of an individual.

The AG’s Office alleges that both defendants defrauded MassHealth in a scheme related to Parisella’s relative, a MassHealth member. Parisella was indicted for stealing from MassHealth by submitting fraudulent PCA timesheets, as the surrogate for her relative. Martel was indicted for defrauding MassHealth by submitting fraudulent claims indicating he had provided ABA services to Parisella’s relative. At the time of the alleged fraudulent billing, Parisella’s relative was inpatient at a hospital or incarcerated, and thus unable to receive MassHealth services.

The AG’s Office began its investigation into Martel after a referral from the Massachusetts Executive Office of Health and Human Services.

The AG’s investigation and indictments follow years of efforts by AG Healey’s Medicaid Fraud Division to combat fraud and misconduct in the PCA program. In addition to securing indictments against seven individuals in a coordinated criminal sweep of fraud and abuse in the state’s PCA program in October 2020, the Division indicted a New Bedford man in July 2021 who allegedly defrauded the program by falsely billing for services he did not receive. In March 2022, four individuals were charged with a scheme to falsely bill the PCA program for services that conflicted with outside employment. In June and September 2022, a Medford man and Lowell man were found guilty and sentenced to jail in separate cases for defrauding MassHealth for PCA services not rendered. Earlier this week, the Division announced charges against two defendants for fraudulent billing for PCA services and sex-related crimes against PCAs.

This case is being investigated and prosecuted by Assistant Attorney General William Champlin and Senior Healthcare Fraud Investigator Heather Dwyer of the AG’s Medicaid Fraud Division. MassHealth, Massachusetts Behavioral Health Partnership, Tempus Unlimited, and the Essex County Sheriff’s Department provided substantial assistance with the investigation.

The Massachusetts Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $5,542,963 for Federal fiscal year 2023. The remaining 25 percent, totaling $1,847,641 for FY 2023, is funded by the Commonwealth of Massachusetts.