The Fraud Division Announces Charges Against 19 Defendants for Medicaid Home Health Aid Scheme

Division Expands Northeast Strike Force to Philadelphia to Target Health Care Fraud Schemes, Provide Full-Spectrum Accountability The Justice Department’s National Fraud Enforcement Division (Fraud Division) announced a major investment in combatting Medicaid fraud through a significant expansion of the Division’s Northeast Health Care Fraud Strike Force to Philadelphia, Pennsylvania, an enforcement initiative uniting the Division’s Health Care Fraud Section with the U.S. Attorney’s Office for the Eastern District of Pennsylvania. The Health Care Strike Force model has proven to be one of the most powerful tools in the federal enforcement arsenal, responsible nationally for the prosecution of over 6,200 defendants who collectively billed federal health care programs and private insurers more than $45 billion. In connection with the announcement, the Fraud Division, U.S. Attorney’s Office, and Pennsylvania Attorney General today announced criminal charges against 19 defendants, including owners and employees of home care companies, for their alleged participation in various fraud schemes involving over four million dollars in claims to Medicare and Medicaid. The Pennsylvania Attorney General also announced a plea agreement involving the final defendant in a previously-charged 21 defendant case involving over $1.7 million in claims. The Fraud Division’s expansion into the Eastern District of Pennsylvania brings enhanced federal resources to a district with an established tradition of strong health care fraud enforcement. The partnership between the Fraud Division and the Eastern District of Pennsylvania will uniquely enable law enforcement to combat criminals who hide behind corporations to commit fraud. Philadelphia and its surrounding areas have vibrant and cutting-edge health care technology and insurance industries, and the Eastern District of Pennsylvania has long been a prime venue for private lawsuits that bring unlawful corporate conduct in the health care industry to the attention of law enforcement. The Unit’s corporate enforcement efforts align closely with the U.S. Attorney’s Office in the Eastern District of Pennsylvania and its history of successful criminal and civil actions against corporate bad actors operating in the health care industry. In particular, the Health Care Fraud Unit has significantly expanded its focus on corporate accountability, resolving cases against companies engaged in systemic illegal conduct, including recent corporate resolutions with AP of South Florida LLC, Atlantic Biologicals Corp., ExThera, and Troy Health Inc. Just last week, the Fraud Division announced the first declination of a health care company under the new Department-wide Corporate Enforcement Policy, which resulted from a voluntary self-disclosure by eye care group Campus Eye. Today’s cases demonstrate that even the boldest fraudsters will be caught and stopped. In one case announced today, four defendants, two purported aides and two Medicaid recipients, were charged in connection with a conspiracy to submit claims for home health services that never occurred. One purported aide claimed to be providing services while she was incarcerated; another purportedly provided services while hospitalized. These four defendants caused over $440,000 in claims to Medicaid. In another of today’s cases, two defendants, father and son, were charged after the son, a purported aide, claimed to be providing services while driving for a ride-share and food delivery service. On one occasion, the defendants claimed services while the son was in the midst of a traffic stop in which he was cited for possession of marijuana; on another, the defendants claimed services while the father was in court participating in a sentencing hearing for another individual. Medicaid paid over $200,000 for care purportedly provided to the father. In a third case being announced today, a purported aide and a Medicaid recipient were charged after the recipient claimed to be so debilitated that he needed dozens of hours of home health assistance, resulting in over $160,000 in claims to Medicaid. In reality, the recipient had a day job as a carpenter working in the construction industry. Social media posts depicting defendant’s vacation to Miami, Florida, while he billed for providing home care services to a Medicaid recipient in the Eastern District of Pennsylvania. The defendants’ conduct was characterized by extraordinary greed. In one case, the Pennsylvania Attorney General charged a purported home health aide who claimed to have provided services to up to seven Medicaid recipients at once. On over 1,100 occasions, the defendant allegedly claimed to have provided care for more than 24 hours in a single day, totaling over 64,000 hours that could not have been worked. As alleged, Medicaid paid over $1.2 million as a result of the scheme. Another defendant who was charged in today’s announcement, a purported aide, claimed to have worked over 8,700 overlapping hours. As alleged, there were nearly 400 days on which the defendant claimed to be working for more than 24 hours in a day. The defendant allegedly caused over $180,000 in loss to Medicaid. In another case, a defendant was charged who claimed to have provided over 1,300 hours of home care services for a Medicaid recipient who was himself incarcerated on state drug charges. A defendant in one case was captured on a recorded conversation stating that “this home health care is the best kept secret . . . I made a buck plus [each of] the last five years, that’s, that’s a half a million dollars . . . I ain’t checking on nobody.” The defendants in today’s announcement were not deterred by the physical impossibility of their claims, as several defendants were charged with claiming to have provided services while they were out of the country. For example, one defendant pleaded guilty to charges brought by the Pennsylvania Attorney General for his claims to be providing home care services while he was, among other places, in Saudia Arabia. Nineteen other defendants previously pleaded guilty in connection with this case. Another defendant, charged by the U.S. Attorney’s Office for the Eastern District of Pennsylvania, allegedly claimed to provide services while traveling overseas on multiple occasions. The defendant caused nearly $600,000 in claims to Medicaid, most of which were fraudulent. Today’s announcement also includes a home care agency, which was charged alongside its two owners. As alleged, the agency and its owners billed Medicaid for hundreds of false and fraudulent clock-ins and clock-outs for home care shifts, falsely representing that two agency employees were providing home care services to clients. In total, the defendants caused Medicaid to pay approximately $224,000 for the affected employees’ purported work.