Justice Department prosecutors have convicted a 61-year-old Torrington woman of felony Medicaid fraud. According to court records, Patricia Lafayette defrauded the Connecticut Medicaid program of $1.6 million. Lafayette faces 10 years in prison when sentenced later this year.
Lafayette’s Medicaid Fraud Scheme
In July of 2016, prosecutors charged Lafayette with a single count of health care fraud. They say she and another individual operated a social service business called Family First Community Support Services. Because she did not have a license to perform psychotherapy services, Lafayette conspired with another individual, Anne Silver, who did have a license. The two then submitted claims to Medicaid under Silver’s billing number. Those claims falsely indicated the counselling services were performed by Silver.
The two agreed that Silver could keep 25% of the money for use of her license and billing credentials.
Under the arrangement, patients were treated by an unlicensed provider. Due to the nature of psychotherapy services, it is difficult to measure the extent of the harm suffered by the patients from services of an unlicensed provider. Because Medicaid is funded by the federal government and the Connecticut Department of Social Services, taxpayers were cheated as well.
At her arraignment, Silver pleaded guilty and is scheduled to be sentenced later in 2016. Anne Silver has also been criminally charged.
Medicaid fraud carries a sentence of up to 10 years in prison. The sentence can be enhanced if a patient suffers harm as a result of the fraud. As part of a plea agreement, both the Justice Department and Lafayette agreed that federal sentencing guidelines call for a sentence of 30 to 37 months. Lafayette must also pay restitution and could have to pay a substantial fine as well.
Connecticut’s False Claims Act
Connecticut has a False Claims Act that pays whistleblowers substantial cash awards for information about Medicaid fraud. People with inside information can receive an award of between 15% and 30% of whatever the government collects. The law also allows the state to triple damages. In a case like this, that could mean an award of well over $1 million.
Healthcare fraud is not a victimless crime. The State of Connecticut requires most healthcare practitioners to be licensed. The state wants to insure that patients receive treatment from providers who possess the proper training and credentials. Licensing also means providers are tested, pass background checks and keep up to date on training. When a healthcare provider allows someone else to use his or her license, the public isn’t protected and serious injuries can occur.
We encourage people with information about Medicaid fraud to come forward and report their suspicions. If you are an “insider” or someone with direct knowledge, you may qualify for an award. Even if you don’t qualify for an award under the Connecticut False Claims Act, putting a stop to fraud is the right thing to do. Whistleblowers are heroes that save taxpayers billions of dollars each year, save lives and put a stop to greed and corruption.