Two lawsuits filed over false billing of Vermont Medicaid

Nick Rees Nov. 25, 2009, 7:00pm

MONTPELIER, Vt. (Legal Newsline) - Two prosecutions have been announced by Attorney General William Sorrell and the U.S. Attorney for the District of Vermont relating to schemes to defraud the Vermont Medicaid Program.

The prosecutions come as part of a joint investigation by both state and federal law enforcement and involve allegations of fraud against Vermont Medicaid's Children's Personal Care Services program.

Valerie Tofani of Barre, Vt., was arraigned in Vermont District Court for Windsor County on five felony counts of Medicaid fraud and five misdemeanor counts of false pretenses.

Tofani is accused of submitting payment claims for care provided under Vermont Medicaid's Children's Personal Care Service program when she actually provided no such care. Tofani is also alleged to have forged another person's signature on the claims, which falsely authorized payment for herself.

Tofani pleaded not guilty to the charges. She faces penalties of as much as 55 years imprisonment or a fine of up to $10,000, or both, if convicted.

In the other case, an indictment was returned by the Grand Jury sitting in Burlington accusing Taylor Riff of Windsor, Vt., of engaging in a conspiracy with others to submit 40 false time sheets to Vermont Medicaid. The time sheets claim that children had received aid under the Children's Personal Care Services program despite no such care being provided.

These submissions, the Grand Jury alleged, resulted in Vermont Medicaid paying over $40,000 for services that were not provided. Riff then shared these payments, the indictment alleges, with at least one member of the conspiracy.

If convicted, Riff faces a potential sentence of as much as five years in prison. He is scheduled to be arraigned next week.

The state's Children's Personal Care Services program provides supplemental assistance to eligible children with significant disability or health conditions for self-care and activities of daily living at home and in the community.

Families of eligible children are provided with the option of selecting the individuals to provide personal care in their homes and the time when care is provided by the Children's Personal Care Services program. The defendants in the two cases are accused of taking advantage of this built in flexibility to defraud the program.

Two other individuals have been separately charged recently with multiple counts of fraud for allegedly submitting false time sheets for respite and personal care services.

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