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Two Recent Guilty Pleas Expose Rampant Medicaid Fraud


Medicaid provides health coverage to millions of Americans. They include eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by both states and the federal government. Unfortunately, Medicaid is also a constant victim of fraud.


In the past week, two individuals pleaded guilty to crimes connected to defrauding Medicaid. According to the District of Columbia branch of the United States Department of Justice, a Maryland’s man’s guilty plea is the twelfth in the U.S. District Court for the District of Columbia since August of 2018. “Six of those aides were sentenced to 13 months in prison; a seventh and eighth were sentenced respectively to 15 months and 10 months,” the DoJ report informs.


Joseph Tamjong pleaded guilty to defrauding the D.C. Medicaid program.


This past Monday, the 51 year-old admitted to a fraud scam totaling $733,405. Tamjong was employed as a Personal Care Aide and/or a Participant-Directed Worker between December 2014 and February 2022. His responsibilities included providing personal care aide services to residents of the District of Columbia. These individuals required assistance with performing daily living activities. They included getting in and out of bed, bathing, dressing and eating.


In court documents, Tamjong admitted that he submitted false timesheets. On them, he claimed to have provided the aforementioned personal care services when he actually did not. “As part of his scheme, he even caused Medicaid to be billed for approximately 3,400 hours of services that he purportedly provided when he actually was traveling internationally,” reports the DoJ, “On 156 separate occasions, he also caused Medicaid to be billed for 24 hours of services that he allegedly provided in one day.”


Guilty of health care fraud, Tamjong now faces a maximum of ten years in prison. The DoJ estimates, however, that he will receive a recommended sentence of between 27 and 33 months. He has already agreed to pay $733,405 in restitution as well as $396,155 in a forfeiture money judgment. Sentencing is scheduled for March 7, 2023.


Kaylie Esquivel Arizmendi pleaded guilty to making false statements.


This past Monday also saw a New Hampshire woman plead guilty to defrauding Medicaid. The 32 year-old resident of Nashua admitted to fraudulently obtaining Supplemental Nutritional Agricultural (SNAP) (better known as food stamps) and Medicaid benefits. As the District of New Hampshire branch of the United States Department of Justice reports, eligibility for such benefits is tied to household resources.


Applicants are required to provide truthful information to the state. They must also notify the state if their household’s composition or income changes in a timely manner. Arizmendi was married in February 2015. On March 3, 2015, she applied to the Department of Health and Human Services for food stamps and Medicaid benefits. She claimed, however, that she was unmarried right up until November 2020. This act is considered perjury.


“If Arizmendi truthfully disclosed her marital status, her spouse’s income would have reduced her eligibility for benefits,” explains the DoJ, “In total, Arizmendi obtained $64,401 in food stamps and Medicaid benefits she was not entitled to receive.” Her sentencing is scheduled for March 13, 2023.


Are you an attorney working on a fraud case?


Allegiant Experts coordinates and supports courageous whistleblowers that shine lights on fraud, waste and abuse. Contact us today to schedule a complimentary consultation. Give us a call at 407-217-5831 or email us at info@allegiantexperts.com.

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