Cruising Along

41672793 - male nurse taking pulse of senior patient at hospital.

On average, Fairbanks, Alaska gets about 65 inches of snow and around 11 inches of rain each year. Temperatures can range anywhere from -17 degrees to 52 degrees Fahrenheit, averaging around 27 degrees. (Needless to say, it sounds pretty cold and gloomy.) A personal care attendant from Fairbanks, who was most likely tired of the weather, funded many vacations by fraudulently billing Medicaid for more than $50,000 in services she did not provide. She was cruising along committing Medicaid fraud by having her children fill in for her while she was off on her adventures.

The Fairbanks woman in today’s fraud article was employed for approximately six years as a personal care assistant (PCA) for a company located in Delta Junction. During her time of employment, she apparently left the state on multiple occasions, but still submitted time sheets and notes about her clients, even though she was not caring for them. The woman received payment from Medicaid for her services, then paid her 32-year-old son and 31-year-old daughter to help take care of her clients. (She was probably laying on the lido deck while charging the government healthcare program for her services.)

Somewhere along the way, Medicaid Fraud Control Unit (MFCU) investigators examined the PCA claims associated with today’s fraudster and two clients she purportedly served. They also took a look at her, and other family members, Alaska Airline travel records. The MFCU investigators cross referenced her timesheets and determined that she was travelling outside of the State of Alaska instead of providing the $50,484.32 in services billed to Medicaid. (She pre-signed her timesheets, then had her son and daughter take care of her patients while she was out gallivanting around.) Court records show that she would typically compensate her children with Medicaid funds by transferring the money electronically when she was gone for longer periods. She paid her kids in cash when she returned from shorter trips. (It’s nice of her to shortchange the government to pay her kids with illegally-gained funds.)

Let’s take a look at her children for a moment. Her son, who lived in Delta Junction, is also a certified PCA with the same company as his mother. His Medicaid billing claims showed that he provided services to one Medicaid recipient who was not one of the two clients claimed by his mother. (If this was a legal arrangement, the son would have signed the timesheets for his mother’s clients and given his own provider ID number.) The woman’s daughter, who also resides in Delta Junction, is not an enrolled PCA. That means that she did not receive the required training, nor did she have a background check. (Thankfully, it does not appear that anything bad happened while the uncertified daughter was caring for her mother’s clients.)

Acting as her own attorney, the 57-year-old former PCA pleaded guilty to Medicaid fraud and was given a suspended entry of judgment and three years of probation. She must also pay a $5,000 fine, perform 72 hours of community service and pay back more than $50,000 she received. If the Fairbanks fraudster commits another crime, she could get up to 18 months in prison. (To comply with her plea agreement, she must have a yearly hearing to ensure she’s following the terms to which she agreed.)

What’s interesting about this Medicaid fraud case is that during her hearing, she asked to have her passport returned so that she could take a cruise. (Does anyone see the irony?) The judge told her that she would have to get permission from her probation officer to travel outside the State of Alaska. (How does she think she is going to fund her trips? I have a sneaking suspicion that we may see this offender again if she doesn’t set a straight course for earning an income in a legitimate manner.)

Today’s “Fraud of the Day” is based on an article entitled, “Delta Junction woman sentenced for $50,000 Medicaid fraud,” published by Daily News-Miner on December 28, 2018.

FAIRBANKS—A former personal care attendant who fraudulently billed Medicaid for $50,484 in services she did not personally provide was sentenced Wednesday in Fairbanks Superior Court.

Sirje Kulakevich, 57, of Delta Junction, pleaded guilty to one count of felony medical assistance fraud and was given a suspended entry of judgment and three years probation.

Previous articleThe One That Got Away
Next articleKickbacks, Bribes and Narcotics, Oh My!
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.