ROCKY HILL, Conn. — A East Windsor business owner was arrested on charges she falsely billed Medicaid over $50,000 in charges for services that were never rendered.
Karen Gaston, 39, of East Granby, owns Elegant Clinical Corporation in East Windsor. Gaston is charged with billing Medicaid for services that were never provided to the purported recipients.
State officials said Gaston was charged Tuesday with one count each of Larceny in the First Degree by Defrauding a Public Community, Health Insurance Fraud and Criminal Attempt to Commit Larceny in the First Degree by Defrauding a Public Community.
Officials said, "According to the arrest warrant affidavit, a 2018 audit of Elegant Clinical Corporation Medicaid billings by the Connecticut Department of Social Services, which administers the state’s Medicaid program, revealed a 57% error rate in which Medicaid was billed for services not provided. Subsequent investigation disclosed numerous conflicting claims, where the client was actually being treated elsewhere on dates billed by Elegant Clinical. Additionally, most of the visits billed by Elegant Clinical were supported by false or blank documentation in the clients’ files. In all, Medicaid was falsely billed $52,648.97 for ten clients that never received the billed-for services.
Medicaid is a federal and state-funded program that provides health care for low and no-income individuals.
Gaston was released on a $75,000 bond and is scheduled to appear in Hartford Superior Court, G.A. No. 14, on September 30. Larceny in the First Degree by Defrauding a Public Community and Criminal Attempt to Commit Larceny in the First Degree by Defrauding a Public Community are both class B felonies, each punishable by up to 20 years in prison. Health Care Fraud is an unclassified felony punishable by up to 5 years in prison.
