The Wisconsin Department of Justice has filed criminal charges in separate cases against two women accused of defrauding Wisconsin Medicaid through the state’s IRIS program.
Forty-eight-year-old Zambia Bell of Milwaukee is charged with ten counts of Medical Assistance Fraud and one count of Theft by Fraud. Forty-five-year-old Carolyn Franco of Pueblo, Colorado, is charged with three counts of Medical Assistance Fraud and one count of Theft by Fraud.
According to the criminal complaints, both women worked as personal care providers for individuals they knew through Medicaid’s Include, Respect, I Self-Direct, or IRIS, program. Prosecutors allege the women submitted fraudulent timecards claiming they worked hours they did not actually provide care.
Investigators allege Bell submitted timesheets showing she worked more than 24 hours in a single day on 437 occasions, resulting in payments of at least $43,081 from Wisconsin Medicaid. The complaint further alleges that, even assuming she worked 16-hour days, she fraudulently received more than $100,000.
The complaint against Franco alleges she submitted timecards for dates when she was in another state and could not have been providing care. Investigators allege she defrauded Wisconsin Medicaid of at least $16,000.
Attorney General Josh Kaul said the Department of Justice remains committed to protecting the integrity of government programs and pursuing cases involving alleged Medicaid fraud.
The charges are allegations, and both defendants are presumed innocent unless and until proven guilty in court.
The cases were referred to the Department of Justice by the Wisconsin Department of Health Services Office of the Inspector General. The investigations were conducted by the DOJ’s Medicaid Fraud Control and Elder Abuse Unit and Division of Criminal Investigation.
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