Attorney General Fox Announces Medicaid Fraud Case Successfully Prosecuted

Attorney General Fox Announces Medicaid Fraud Case Successfully Prosecuted

Attorney General Tim Fox announced that a Missoula couple who recently pleaded guilty to defrauding Montana’s Medicaid program will pay more than $22,000 in restitution.
On October 2, 2012, the Montana Attorney General’s Office charged Nateese Ryan Pate, 37, and Michael William Pate, 28, both of Missoula, in Missoula County District Court with one count each of Theft by Deception, Common Scheme, a felony; and one count each of Theft of Public Assistance, common scheme, a felony; and one count each of Conspiracy to Commit Theft by Deception, a felony; and one count each of Conspiracy to Commit Theft of Public Assistance, a felony.

“This couple knowingly defrauded Montana’s Medicaid program,” said Attorney General Tim Fox. “We all have an interest in making sure taxpayer dollars are spent as they should be. The Montana Department of Justice will continue to keep an eye out for abuse of our public programs, and vigorously prosecute those who defraud the system.”

On June 25, 2013, both defendants entered guilty pleas before Karen Townsend, District Judge, to Count II, Theft of Public Assistance. After a pre-sentence investigation was conducted, the defendants were sentenced on September 30, 2013. Nateese Pate was sentenced to six years at the Montana State Women’s Prison, sentence deferred, placed on supervised probation, and ordered to pay $22,773 in restitution to the Montana Medicaid Program in addition to other court ordered fees. The court imposed several additional conditions of probation, including that Nateese Pate may not gamble or enter any casino.

Michael Pate received a six-year deferred imposition of sentence. He was likewise ordered to jointly pay the $22,773 in restitution to the Montana Medicaid Program and was prohibited from gambling. The remaining charges against both defendants were dismissed.

The investigation by the Montana Department of Justice’s Medicaid Fraud Control Unit began with a referral from a Missoula company, Summit Independent Living Center, which provides home health services to Medicaid-eligible consumers. Under the Self-Directed Personal Assistance Services program, a consumer/Medicaid recipient hires their own caregiver, called a personal care assistant (PCA). The consumer and agency, in this case SILC, develop a care plan which establishes how many hours the PCA is authorized to work and what services are to be provided. The PCA is required to keep track of the hours they work and record them on timesheets. The timesheets are reviewed, verified, and signed by the consumer before submission to the provider agency, SILC. After the agency pays the PCA, it submits a claim to the Montana Medicaid program, which reimburses the agency for the PCA’s time and for administering the care plan.

SILC informed Nateese Pate, formerly Nateese Stevens, that a spouse of a Medicaid recipient is not eligible for reimbursement for PCA services. The Montana Department of Justice’s investigation revealed that Michael Pate became Nateese’s PCA in January 2007. On July 4, 2009, the couple married.

Subsequent to that time, Michael was no longer eligible to be paid by the Medicaid program as a PCA for Nateese. Neither Michael nor Nateese notified SILC of the change in their marital status. They continued to submit timesheets indicating that Michael was performing PCA services for Nateese until June 21, 2011. Nateese continued to use her maiden name to sign the timesheets, even though she had legally changed her last name to Pate at the time of the marriage. SILC became suspicious when Michael changed his mailing address to that of Nateese’s residence, but denied living there. That suspicion, along with an internet posting regarding the marriage, spurred the Medicaid Fraud Control Unit’s investigation.

Attorney General Fox added, “I want to commend Debrah Fosket, Director of our Medicaid Fraud Control Unit, and Assistant Attorney General Ken Varns for their diligent work on this case, and for protecting Montana’s public resources for those who truly need them.”

No charges or civil actions were brought against SILC, as the agency was unaware of the Pates’ fraudulent conduct until it made the referral to the Medicaid Fraud Control Unit.

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