Brother, sister accused of falsely claiming to have Hepatitis C in scheme that victimized nonprofit in Hampton

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HAMPTON, Va. - A brother and sister are accused of allegedly faking having Hepatitis C to scheme money from a nonprofit organization, according to court records.

It's an alleged scheme that went on for over a year in the offices at Patient Advocate Foundation in Hampton.

Court records state five former employees from Patient Advocate Foundation were working with patients to falsify claims.

Some patients even claimed to have Hepatitis C when they didn’t.

A brother and sister are now facing health care fraud charges.

Records state the brother dated an employee and his sister knew an employee.

Patient Advocate Foundation helps people pay medical bills and records state the nonprofit helps those with an annual household income of less than $50,000 and provides them with grants.

The money comes from private pharmaceutical companies and not from any federal program, according to the court documents.

Records indicate there were 12 patients involved in 27 fake claims which cost over $225,000.

“Basically, stealing from the organization that they work for,” said Legal Analyst Martin Thomas, an attorney with the Decker Law Firm.

Martin called this case unusual because there were several employees allegedly working together.

"In furtherance of the scheme, the participating PAF employees facilitated the fabrication, submission, entry, and approval of documents supporting the patients' diagnoses and claims in PAF's system," according to the criminal information.

Records state sometimes information would entered manually. The patients were mailed a check which they cashed and proceeds were shared among those involved in the false claim, according to the court records.

Caitlin Donovan, the Director, Outreach and Public Affairs with Patient Advocate Foundation issued the following statement:

“Patient Advocate Foundation quickly took appropriate action during this incident. Although PAF cannot comment on an ongoing criminal prosecution, our accounting controls worked as they should and uncovered the fraud. PAF also cannot comment on matters of employee discipline; however, we were able to identify the alleged wrongdoers and deal with the situation appropriately and swiftly. We have initiated actions to recover any funds that may prove to have been fraudulently obtained. 

Please be assured that grants, funds and services for patients have not diminished as a result of this incident.  As always, PAF takes pride in its mission of safeguarding patients through effective mediation, helping patients access care, maintain employment and preserve their financial stability.”

Martin said he anticipates more charges to be filed.

The names of the employees were not listed and it's unclear if they are facing charges.

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