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April 2, 2024

Four Worcester healthcare providers indicted for alleged Medicaid fraud scheme

A woman in a suit stands at a podium outside Image | Courtesy of Alison Kuznitz, State House News Service Massachusetts Attorney General Andrea Joy Campbell speaks to reporters.

Four Worcester individuals have been indicted for their alleged involvement in a local personal care attendant and home health Medicaid fraud scheme, according to a Monday announcement from the Office of Massachusetts Attorney General Andrea Joy Campbell. 

The indictments allege since at least 2019, the four defendants billed at least 17 MassHealth members a total of more than $500,000 to MassHealth for home health services that were not provided, including services by personal care attendants (PCAs), home health aides, or adult foster care caretakers, according to the AG’s announcement. MassHealth is the Massachusetts Medicaid program.

Felix Mercedes, of Worcester, has been charged with 11 counts, including four counts of Medicaid false claims, one count of larceny over $1,200, one count of identity fraud, two counts of conspiracy to commit larceny and Medicaid fraud, two counts of witness intimidation, and one count of money laundering. As of the time of the release, Mercedes is being held on a $25,000 cash bail.

His three co-conspirators, Elizabeth Betances Rosario, Yaneris Mercedes De Rivera, and Yenifer Barrera, who are all from Worcester, were each indicted on two counts of Medicaid false claims and various counts of larceny over $1,200. Each posted a $2,500 cash bail. 

“The defendants in this case unlawfully exploited vulnerable individuals, including disabled and unhoused victims, in order to cheat the system for their own personal gain,” Campbell said in the Monday press release. “As thousands across Massachusetts continue to rely on MassHealth to receive critical health care services, my office will continue to hold such bad actors accountable to ensure our public resources are protected for the benefit of those who truly need them.” 

The defendants targeted vulnerable members of the community, including unhoused and disabled individuals, through the MassHealth PCA program, according to the press release. They allegedly signed up and billed these individuals for MassHealth services, often without their knowledge or consent, for services, including those critical and medically necessary, they did not provide.

In turn, the indictment alleges the MassHealth funds were used by Mercedes and his co-conspirators for personal expenses, including travel, lifestyle, jewelry, and various luxury items, along with a downpayment on a home in Worcester, according to the release. 

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