HARTFORD, Conn. — An East Hartford man who submitted thousands of fraudulent claims to Medicaid was sentenced to prison on Wednesday in Hartford Superior Court, the state’s Division of Criminal Justice said in a release.
Ramon Apellaniz, 39, received an eight-year prison sentence, execution suspended after 15 months served, with five years of probation, the release said.
Apellaniz was found to have sent thousands of fraudulent claims to Medicaid for services provided by unlicensed personnel and for services not provided. He also stole the identity of a licensed professional to submit fraudulent claims, according to the release.
Apellaniz has paid $156,000 in restitution, and the remaining $753,269 must be paid during probation.
On Sept. 12, 2023, Apellaniz pleaded nolo contendere to one count of first-degree larceny by defrauding a public community, one count of health insurance fraud and one count of first-degree identity theft; all charges are classified as B felonies, according to the Division of Criminal Justice.
The Medicaid Fraud Unit in the Office of the Chief State’s Attorney discovered that Apellaniz was not licensed to provide counseling services but was nonetheless 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.”
The Division of Criminal Justice noted that Medicaid Fraud Control Unit inspectors found that 9,717 of the 12,771 claims submitted by Gemino Project between January 2018 and July 2019 were for services provided by unlicensed persons, such as Apellaniz himself, who treated patients without being a licensed counselor.
Additionally, 462 claims were submitted for services that were not rendered by anyone, the release states, adding that Apellaniz used the provider number of a licensed provider, without the individual’s knowledge or consent, to submit the fraudulent claims and obtain $909,369 in fraudulent billings.
The state’s Medicaid Fraud Control Unit prosecuted the case and was assisted by the state’s Department of Social Services – Office of Quality Assurance, the state Attorney General’s Office, and the New Britain Police Department.
The release from the Division of Criminal Justice states that the Medicaid Fraud Control Unit receives 75% of its funding from the U.S. Department of Health and Human Services through a grant award totaling $2,988,308 for the fiscal year running from Oct. 1, 2023, to Sept. 30, 2024. The remaining 25% amounts to $996,0999 for the same fiscal year and is funded by the State of Connecticut.
Those who have knowledge of suspected fraud or abuse in the public healthcare system are asked to contact the Medicaid Fraud Control Unit at 860-258-5986.
----
Dalton Zbierski is a digital content producer at FOX61 News. He can be reached at dzbierski@FOX61.com.
----
Do you have a story idea or something on your mind you want to share? We want to hear from you! Email us at newstips@fox61.com.
----
HERE ARE MORE WAYS TO GET FOX61 NEWS
Download the FOX61 News APP
iTunes: Click here to download
Google Play: Click here to download
Stream Live on ROKU: Add the channel from the ROKU store or by searching FOX61.
Steam Live on FIRE TV: Search ‘FOX61’ and click ‘Get’ to download.
