Skimming

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Calculator and stethoscope on paperwork

Fraudsters like to remain incognito by skimming just a little bit off the top over time. They figure that no one will notice they are taking extra for themselves. The tactic didn’t work for Giovanne Gomez of Providence, R.I., who pleaded nolo contendere to committing Medicaid fraud. (This means Gomez accepted the conviction as if she had entered a guilty plea, but it does not admit her guilt.)

Gomez, 32, served as a manager at Cranston-based A Caring Experience Nursing Services (ACE), an organization that assists nurses and healthcare professionals in securing temporary home-based services job assignments. While employed there, she had access to Medicaid recipients’ records and the company’s employees’ timesheets. (I bet you can almost guess what she did next.)

Gomez used her position to create fake timesheets for 30 Certified Nursing Assistants, citing services provided to approximately 100 Medicaid beneficiaries. (They were never provided.) She then diverted the $120,605.78 she received from the Rhode Island Medicaid program into two bank accounts that she and several co-defendants controlled.

Both bank accounts belonged to a business owned by her husband, Thomas Espinal. Together, the fraudulent couple made numerous cash withdrawals from the accounts, tendered checks, and made wire transfers using the funds stolen from ACE.

Gomez was sentenced to serve six years at the Adult Correctional Institution (ACI), with one year served in home confinement and the other five years suspended with probation. She was also ordered to repay ACE a $84,106.25 in restitution. (With stay-at-home orders still encouraged, Gomez will have no problem keeping herself indoors). Her husband also pleaded nolo contendere and was sentenced to serve three years of probation. Three co-conspirators have been charged with felony counts for their alleged involvement in the Medicaid fraud scheme. 

If you suspect Medicare or Medicaid fraud, please report it by calling 1-800-447-8477 or via email at HHSTips@oig.hhs.gov.

Today’s Fraud of the Day comes from an article, “Providence woman ordered to repay $84,000 in Medicaid fraud case,” published by The Providence Journal on December 23, 2020.

PROVIDENCE — A Providence woman has been sentenced to a year of home confinement and ordered to pay more than $84,000 in restitution to her former employer for her role in a Medicaid fraud scheme, prosecutors said in a statement Wednesday.

Giovanne Gomez, 32, was sentenced last week after pleading no contest to obtaining money under false pretenses from the Rhode Island Medical Assistance Program, according to a statement from the office of Attorney General Peter Neronha.

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Larry Benson
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.