State, Federal Prosecutors Pursue Medicaid Fraud Cases

11/25/09 5:50PM By John Dillon
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(Host) State and federal prosecutors have launched a joint fraud investigation of the Medicaid health-care program.

The probe so far has resulted in criminal charges against two women. Officials said more charges could be filed as the investigation continues.

VPR's John Dillon reports:

(Dillon) The two criminal cases involve payments from the Medicaid Children's Personal Services program, which helps cover expenses for low income, disabled children.

The charges stem from a joint federal and state investigation that has centered on allegations of false claims for reimbursement.

Linda Purdy is an assistant attorney general.

(Purdy) "This type of initiative was started because we began to see a high volume of this particular time-sheet fraud case where people who were supposed to be providing needed services to severely disabled children or adults were falsifying time sheets and saying they provided the service when, in fact, we allege that they did not. And so we combined the federal and state enforcement efforts."

(Host) The state attorney general's office says Valerie Tofani of Barre claimed Medicaid payments for care she did not provide. And a federal grand jury in Burlington has returned an indictment against Taylor Riff of Windsor. The indictment says Riff submitted false time sheets to the Medicaid program.

Purdy says the joint investigation will continue.

(Purdy) "We have been working together and will continue to work together. These types of cases - any type of Medicaid fraud, Medicare fraud that involves the public health care system - is a betrayal of the public trust. And in this time of great state fiscal crisis, any tax dollar counts, any health care dollar counts, and so we will be seeing more enforcement efforts, both on the state and federal side."

(Dillon) The federal grand jury says the alleged fraud committed by Taylor Riff cost Vermont Medicaid about $40,000. In the state case, the allegedly false claims cost the program about $12,000.

Purdy says the children's services program is not audited on a regular basis. So she says part of the enforcement effort will involve helping state employees learn how to detect potential fraud.

(Purdy) "Part of this initiative is working with the state agencies that do provide oversight, and doing a training, and basically teaching them and educating them on what to look for and how to tighten up their own procedures in terms of how to prevent some of this from happening in the first place."

(Dillon) The joint state and federal investigation resulted in charges against two other people earlier this year. 

For VPR News, I'm John Dillon in Montpelier.

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