A Philadelphia woman is being charged with Medicaid fraud and five counts of tampering with public records by the Pennsylvania Attorney General’s office for allegedly falsifying direct care services through a Bensalem based home care services provider.
Gretchen Alston, 59, according to a criminal complaint, was required to provide services to two individuals at their shared residence. State investigators say she submitted fraudulent time sheets billing for more hours than it’s possible to work, the Office of the Attorney General, says.
After a service was provided, Alston was required to fill out and submit weekly time sheets to Outstanding and Progressive, indicated when she provided her services during a specific time frame, state officials say.
According to state investigators, between the period of December 23 2018 and March 23 2019, Alston submitted times sheets that stated she had worked 24 hours each day for the two people she was caring for, resulting in an overlap.
She did this again between August 11,2019, and August 24, 2019, the criminal complaint alleges.
The Community HealthChoices (CHC) and Attendant Care Waivers are home and community based waiver programs provide a variety of services to eligible individuals in a community based setting, to insure they don’t have to be placed in a nursing homes, for example.
One of the services available under each waiver is a DCW who assists with activities of daily living, according to court records.
State investigators spoke with the owner of Outstanding Homecare Solutions, Sarah Tingue.
Tingue, according to court records, said Alston was supposed to work as a client DCW for 12 hours during the day and work 12 hours at night for a second client, with anther DCW to care for LM during the day to avoid Alston’s hours overlapping between the two individuals she was taking care of.
Tingue said overlapping hours between service recipients is against the agencies policy and that Alston was timely made aware of this, court records show.
Tingue accused Alston of pushing other assigned staff away so she could take care of the individuals herself, the criminal complaint alleges.
Alston billed for more hours in a day than is possible, resulting in Medical Assistance paying over $10 thousand for fraudulent hours, investigators allege.
Alston is being charged with one count of Medicaid fraud, one count of theft by deception, and five counts of tampering with public records.
Magisterial District Judge Michael W. Gallagher set bail as unsecured .
Alston is scheduled to appear on August 16 for a preliminary hearing in Bensalem District Court.
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