CT behavioral health worker barred from working with Medicaid sentenced for health care fraud

A behavioral health provider from Waterbury has been ordered to pay $25,000 in restitution for Medicaid fraud.

A Waterbury behavioral health provider who was previously convicted of Medicaid-related crimes and was barred from working with the program has now been convicted of health care fraud involving Medicaid and ordered to pay $25,000 in restitution, records show.

Elijah Caldwell, 43, appeared in court in Hartford on Thursday and was sentenced to three years in prison, execution suspended, followed by three years of conditional for providing behavioral health services to Medicaid clients and billing Medicaid for those services while he was not allowed to work with Medicaid due to a prior criminal conviction, according to the Division of Criminal Justice.

The sentence means Caldwell will not serve time in prison but will have to pay restitution and has been ordered to not act as a Medicaid provider, officials said.

Caldwell had previously been barred from participating in Medicare, Medicaid and all federal health care programs for 10 years, according to the DCJ. Court records show that he was convicted of third-degree forgery and fourth-degree larceny in 2018.

An investigation by the Medicaid Fraud Control Unit of the Chief State’s Attorney’s Office found that between Oct. 2019 and January 2020, Caldwell provided behavioral health services at Primal Mental and Physical Health in Oakville and billed Medicaid, according to the DCJ.

Officials said that Caldwell submitted claims to the Department of Social Services “knowing they contained false, incomplete, deceptive and misleading information.”

Caldwell pleaded nolo contendere to the health care fraud charge.

Suspected fraud or abuse in public health care can be reported to the Medicaid Fraud Control Unit at the Chief State’s Attorney’s Office at 860-258-5986.