Jail, fines for Medicaid fraud

ANCHORAGE — The operator of a former respite and activity center received an effective 120-day sentence for Medicaid fraud at a local activity center, authorities said.

Laura Sasseen, the former operator of the Palmer-based Mat-Su Activity and Respite Center, had previously pleaded guilty to a single count of altering medical assistance records, according to Assistant Attorney General Andrew Peterson with the Alaska Medicaid Fraud Control Unit. The case stems from a 2012 audit of services billed to the state-administered program in 2009 and 2010, conducted by the Department of Health and Social Services and accounting firm Myers and Staufer.

Sasseen pleaded guilty and was sentenced April 8 to 360 days in jail with 240 suspended, a suspended fine of $5,000, 160 hours of community service and 10 years of probation, during which she will be barred from billing Medicaid. Sasseen is also prevented from challenging her audit before an administrative judge.

Auditors performing a desk audit in 2012 noticed some discrepancies among documents selected at random for a statistical audit of the business, Peterson said. That “desk audit” in turn triggered a “site audit,” where accountants travelled to the center to examine the records in person. During the site audit, they discovered documents had been changed to the tune of $37,000 within the small sample of documents they examined. Auditors then used statistical models to apply that rate of fraudulent billing to all of the center’s Medicaid records, which lead to the $1.6-million figure, Peterson said.

Medicaid patients are typically given a service authorization containing a maximum amount, Peterson said. Often, providers won’t pay out the maximum amount, leading to irregularities in the amount billed, he added.

Auditors found fewer than expected irregularities among Sasseen’s records, Peterson said.

“What the evidence suggested was that there was simply billing based on the service authorization, not the actual hours provided,” he said. “When Ms. Sasseen went back in and started looking at the documents, she realized this and made some changes.”

Those changes are what prompted criminal charges in the case, Peterson said.

“If Ms. Sasseen had simply submitted the documents, she would have had the opportunity to challenge the finding in front of an administrative court judge,” he said.

Ultimately, the judge may have decided to levy a less severe fine, Peterson said. Instead, the changes lead to one charge each of falsifying business records by destroying the true entry, and a single count of medical assistance fraud by false entry. Prosecutors dismissed the false business records charge, court records show.

The sentencing may represent something of a victory for taxpayers, because federal officials seized the $1.6 million amount from the state program after discovering the fraud, according to Peterson.

The conviction and plea — and a yet-to-be determined judgment of Sasseen’s inability to pay the money back — could allow the state to recover about $800,000 from the federal program, Peterson said.

A court case against the company has yet to be resolved, Peterson added. That case could result in a $2.5-million fine levied against the company upon conviction.

Contact Brian O’Connor at 352-2269, brian.oconnor@frontiersman.com, or on Twitter @reporterbriano.