State of Connecticut Division of Criminal Justice
04/17/2024 | Press release | Distributed by Public on 04/17/2024 14:43
East Hartford Man Sentenced for Medicaid Fraud
Press Releases
04/17/2024
East Hartford Man Sentenced for Medicaid Fraud
FOR IMMEDIATE RELEASE
(Rocky Hill, CT) - An East Hartford man was sentenced today in Hartford Superior Court for submitting thousands of fraudulent claims to Medicaid for services provided by unlicensed personnel, services not provided, as well as for stealing the identity of a licensed professional in order to submit the fraudulent claims.
The Honorable David P. Gold sentenced Ramon Apellaniz, age 39, to eight years in prison, execution suspended after 15 months served, with five years of probation. The defendant paid $156,000.00 in restitution, with the remaining $753,269.00 to be paid during probation.
Apellaniz plead nolo contendere on September 12, 2023, to one count of Larceny in the First Degree by Defrauding a Public Community, in violation of Connecticut General Statutes § 53a-122(a)(3), one count of Health Insurance Fraud, in violation of Connecticut General Statutes § 53-442, and one count of Identity Theft in the First Degree, in violation of Connecticut General Statutes § 53a-129(b). All charges are classified as B felonies.
An investigation by the Medicaid Fraud Control Unit in the Office of the Chief State's Attorney determined that Apellaniz was not licensed to provide counseling services but was listed as the sole principal of the Gemini Project, LLC., a Newington business that offered counseling to numerous patients with mental, behavioral and emotional disorders, but employed only one professional who was actually licensed to do so.
Medicaid Fraud Control Unit Inspectors determined that 9,717 of the 12,771 claims submitted by Gemini Project for an 18-month period between January of 2018 and July of 2019 were for services provided by unlicensed persons, including Apellaniz himself, who saw patients though he was not licensed as a counselor. A total of 462 claims were submitted for services that were never rendered by anyone. Apellaniz used the provider number of a licensed provider, without their knowledge or permission, in order to submit the fraudulent claims and obtain $909,269.00 in fraudulent billings.
The case was prosecuted by the Connecticut Medicaid Fraud Control Unit. The Unit is grateful for the assistance it received from the Connecticut Department of Social Services - Office of Quality Assurance, the Connecticut Attorney General's Office, and the New Britain Police Department.
The Connecticut Medicaid Fraud Control Unit receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $2,988,308.00 for the fiscal year of October 1, 2023 through September 30, 2024. The remaining 25 percent, totaling $996,099.00 for the same fiscal year, is funded by the State of Connecticut.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Medicaid Fraud Control Unit at the Office of the Chief State's Attorney at (860) 258-5986.