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Post date: December 7 2015

A.G. Schneiderman Announces Guilty Plea of Two Capital Region No-Show Personal Care Aides Who Bilked Medicaid

Aides Submitted False Records To CDPHP, Each Causing Over $1,000 In Theft To Medicaid 

Schneiderman: Those Who Exploit The Medicaid Program Will Be Held Accountable

ALBANY- Attorney General Eric T. Schneiderman today announced the guilty pleas of two personal care aides, Robert Lee Van Horne, 33, of Schenectady, and Nicholas Gallup, 27 of Schenectady, for submitting false time sheets to Capital District Physicians Health Plan (CDPHP), causing over $1,000 in each in theft to Medicaid. The defendants submitted false claims for providing care to a Medicaid recipient that never occurred.

“When individuals exploit the Medicaid program’s flexibility  and a patient’s vulnerability, it takes away from those who are in need of basic health care services, said Attorney General Schneiderman. “The Medicaid program’s Consumer Directed Personal Assistance Program was intended to provide essential health care services by trusted persons in the patient’s own home, and  those who abuse that trust and steal from Medicaid will be held accountable.”

Gallup entered a plea of guilty to one count Falsification of Business Records in the First Degree, a Class E felony in front of the Honorable Peter Lynch in Albany County Court. Under the terms of his guilty plea, he will be sentenced to a period of incarceration in the Albany County Jail and five years probation. Van Horne entered a plea of guilty to one count Falsification of Business Records in the Second Degree, a Class A misdemeanor and one count of Petit Larceny, also a Class A misdemeanor, also in front of Judge Lynch, and will be sentenced to one and a half years in the Albany County Jail.  Both defendants agreed to pay restitution, to stay away from the Medicaid recipient, and to not participate in the Consumer Directed Personal Assistance Program.

According to the original complaints and their admissions at plea, Van Horne and Gallup were hired to provide in-home personal care services to a Medicaid recipient who required the services due to her health issues, through the billing group Resource for Independent Living, (RCIL) a Medicaid provider, from April through June 2014.  Van Horne and Gallup – who were selected by the recipient to provide the care – agreed to provide care on alternate days.  Van Horne and Gallup never provided services to the Medicaid recipient from April to June 2014, and called into a telephone time-keeping  system to falsely document that they had provided care for the Medicaid recipient.  As a result of the false records, RCIL generated a claim and submitted it to CDPHP for payment. CDPHP issued payment to RCIL; then RCIL issued payment to Van Horne and Gallup.  As a result of the false documentation, Van Horne and Gallup each received over one thousand dollars in Medicaid funds.  

The case was investigated by Investigators Danette Benson and J. R. Benshoff with the assistance of Supervising Investigator Dianne Tuffey and Upstate Deputy Chief Investigator William Falk with the assistance Assistant Chief Auditor-Investigator Charles R. Norfleet.

The case was prosecuted by the Albany Regional Office of the Medicaid Fraud Control Unit of the Office of the Attorney General.  Regional Director Kathleen A. Boland represented the People of the State of New York.  Catherine Wagner is MFCU’s Upstate Chief of Criminal Investigations.  MFCU is led by Acting Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney.  The Criminal Justice Division is led by Executive Deputy Attorney General Kelly Donovan.

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