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Hartford County resident Ramon Apellaniz, 39, of East Hartford, will serve 15 months in prison for submitting thousands of fraudulent claims to Medicaid for services provided by unlicensed personnel and services not provided, as well as for stealing the identity of a licensed professional to submit the fraudulent claims.
Apellaniz, who has paid $156,000 in restitution, was also ordered to repay with the remaining $753,269 to be paid during his five years of probation, according to the Connecticut Division of Criminal Justice.
An investigation by the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney determined that Apellaniz was listed as the sole principal of Gemini Project, LLC. in Newington, which offered counseling services for patients with mental, behavioral, and emotional disorders. Apellaniz was not licensed to provide counseling services, though Gemini employed one licensed person.
Medicaid Fraud Control Unit Inspectors determined that 9,717 of the 12,771 claims submitted by Gemini Project for an 18-month period between January 2018 and July 2019 were for services provided by unlicensed persons, including Apellaniz himself, who saw patients. However, he was not licensed as a counselor.
A total of 462 claims were submitted for services never rendered by anyone. Apellaniz used the provider number of a licensed provider without their knowledge or permission to submit fraudulent claims and obtain $909,269 in billings, court documents show.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Medicaid Fraud Control Unit at the Office of the Chief State’s Attorney at (860) 258-5986.
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