PITTSBURGH, Pa. – Ten residents of Western Pennsylvania, a resident of Georgia, and a resident of South Carolina were charged by a federal grand jury in a 22-count indictment related to a years-long conspiracy to defraud the Pennsylvania Medicaid program, United States Attorney Scott W. Brady announced November 27, 2018.
According to the indictment, between January 2011 and April 2017, multiple home health care companies owned and operated by the conspirators received more than $87 million in Medicaid payments. During that time, all 12 of the defendants, along with other individuals, participated in a wide-ranging criminal conspiracy to defraud the Pennsylvania Medicaid program which resulted in the payment of millions of dollars in illegal Medicaid payments. The indictment sets forth dozens of fraudulent acts by the defendants, including making false claims for services that were never provided, creating fake employees, improperly using consumers’ personal identifying information, and falsifying documentation during state audits of the companies. In some instances, the indictment alleges that the defendants were actually working at other jobs or living out of the area. In other instances, Medicaid claims were submitted for services for consumers who were actually hospitalized, incarcerated, or deceased.
“Home health care programs are critical to the ability of patients with serious physical limitations, especially the elderly, to receive the care they need while remaining independent. Those who provide home health care are expected to deliver services honestly,” said U.S. Attorney Brady. “When criminals cheat and steal from these programs, they not only steal from the taxpayers, but they steal from the most vulnerable members of our community.”
An indictment is an accusation. The defendants are presumed innocent unless and until proven guilty.
Assistant United States Attorneys Eric G. Olshan and Special Assistant United States Attorney Edward Song are prosecuting this case on behalf of the government. The Federal Bureau of Investigation, Pennsylvania Office of the Attorney General – Medicaid Fraud Control Unit, Internal Revenue Service – Criminal Investigation, U.S. Department of Health and Human Services – Office of Inspector General, and United States Postal Inspection Service conducted the investigation of the defendants.