Caregiver found guilty of defrauding Medicaid of nearly $45K by billing for caretaking services in NJ while working at her teaching job in Michigan
MORRIS COUNTY, NJ — Attorney General Matthew J. Platkin and the Office of the Insurance Fraud Prosecutor announced Thursday that a Michigan woman was found guilty after trial of defrauding the New Jersey Medicaid Program.
The guilty verdict came after a four-day jury trial in Morris County before Superior Court Judge Claudia Jones.
Michael Ann Ellis, 62, of Flint, Michigan, was found guilty of all counts of second-degree health care claims fraud, third-degree Medicaid fraud, and third-degree theft by deception. Ellis is detained pending sentencing, facing up to 10 years in New Jersey State Prison and a fine of up to $150,000.
The jury heard testimony that Ellis was the designated caregiver for her ex-boyfriend, who suffered a stroke and required care. In that capacity, she submitted fraudulent timesheets between January 5, 2016, and April 13, 2020, and was compensated by the New Jersey Medicaid Program for caretaking services she never rendered.
The case began with a referral to the Office of the Insurance Fraud Prosecutor – Medicaid Fraud Control Unit (OIFP-MFCU) in June 2020 from Morris County Adult Protective Services (APS).
The investigation revealed Ellis was paid by Medicaid, as part of the Personal Preference Program, to provide up to 56 hours of care per week to her ex-boyfriend. However, the jury heard testimony that Ellis was employed as a substitute teacher in Michigan, and she was working in the teaching position on the same dates she was billing for services rendered in New Jersey.
This was corroborated by witness testimony from a superintendent from one of the Michigan schools, along with timesheets and payroll records with school locations, dates, and hours of substitute teaching duties Ellis performed in Michigan. Further, Ellis’ bank records showed numerous transactions taking place in Michigan, on or around the same dates Ellis was substitute teaching.
As evidenced by the jury’s verdict, it was clear from the evidence that on the same dates Ellis was substitute teaching in Michigan, she was submitting timesheets for reimbursement to Medicaid for care she never rendered in New Jersey. Ellis submitted fraudulent timesheets for 361 dates of service between January 6, 2016, and April 13, 2020, (roughly 3,227 hours), and was paid approximately $45,000 by the Medicaid Program, for services never rendered. The State is seeking restitution at the time of sentencing.
“Flagrant abuse of programs available through Medicaid, like the Personal Preference Program, that were developed to support our citizens in need of care, will not be tolerated,” Platkin said. “The defendant thought she could get away with billing for care in New Jersey when she was in another state. If you think you are not going to get caught, you are wrong.”
“Our detectives and attorneys did an excellent job of uncovering and prosecuting this fraud. We have the tools and talent to hold those committing fraud accountable, as evidenced by this conviction, and we will continue to tirelessly protect the Medicaid Program from abuse,” said Interim Insurance Fraud Prosecutor Al Garcia.
