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State And Federal Governments Announce Joint Efforts To Combat Health Care Fraud

CONTACT: Linda A. Purdy, Assistant Attorney General, (802) 828-5511

November 24, 2009

The offices of the Vermont Attorney General and the United States Attorney for the District of Vermont announced today the initiation of two prosecutions relating to schemes to defraud the Vermont Medicaid Program. These prosecutions have arisen out of a joint investigation conducted by members of both State and Federal law enforcement. Both cases involve allegations of fraud against Vermont Medicaid’s Children’s Personal Care Services program.

In the State case, Valerie Tofani, age 41, of Barre, Vermont, was arraigned today in Vermont District Court for Windsor County on five felony counts of Medicaid Fraud and five misdemeanor counts of False Pretenses. The court imposed conditions of release governing Ms. Tofani’s conduct while this case is pending. According to papers filed in Court, Ms. Tofani is accused of submitting claims for payment for providing care under Vermont Medicaid’s Children’s Personal Care Services program when, in fact, she provided no such care. Court papers also state that Ms. Tofani allegedly forged another person’s signature on these claims, thereby falsely authorizing payment to herself. Ms. Tofani pleaded not guilty to the charges. If convicted, she faces potential penalties of up to fifty-five years imprisonment, or a fine of up to $10,000, or both.

In the federal case, the Grand Jury sitting in Burlington returned an indictment last week accusing Taylor Riff of Windsor of engaging in a conspiracy with others to submit approximately forty false time sheets to Vermont Medicaid pretending that her children had received care under the Children’s Personal Care Services program when, in fact, no such care had been provided. The Grand Jury alleged that these submissions resulted in Vermont Medicaid paying more than $40,000 for services that were not provided. According to the Indictment, Riff shared these proceeds with at least one other member of the conspiracy. Riff is scheduled to be arraigned next week in Burlington. If convicted, Riff faces a potential sentence of up to five years in prison.

Both United States Attorney Tristram J. Coffin and Attorney General William H.Sorrell emphasized that the charges facing Tofani and Riff are accusations only and that both Tofani and Riff are presumed to be innocent unless and until proven guilty.

The State of Vermont provides health care services to some of its low income residents pursuant to the Medicaid Program. The costs of the Medicaid program are shared by Vermont and the Federal government. The goal of the Children’s Personal Care Services, offered by the state Medicaid Program, is to provide supplemental assistance with self-care and activities of daily living to Medicaid eligible children with significant disability or health conditions at home and in the community.

In order to provide flexibility, the Children’s Personal Care Services program provides families of eligible children with the option of selecting the individuals to provide personal care in their homes, and to choose the time when the care is provided. In the cases announced today, the defendants are accused of schemes that take advantage of this flexibility so as to defraud the program.

Both Attorney General William Sorrell and United States Attorney Tristram Coffin noted that these prosecutions reflect the seriousness with which both the Federal and State governments view fraud, waste, and abuse in matters affecting health care. These cases were investigated by the State of Vermont’s Medicaid Fraud & Residential Abuse Unit and the Office of Inspector General of the United States Department of Health and Human Services. Over the past several months, as part of this ongoing initiative the Attorney General’s Office has charged two other individuals separately with multiple counts of Medicaid fraud for their alleged submission of false timesheets for respite and personal care services.

Riff is represented by the Federal Public Defender Michael Desautels and Tofani is represented by Elizabeth Kruska, Esquire.

  Website consulting provided by The National Association of Attorneys General.