Twelve individuals and an agency have been charged by federal indictment, with additional defendants charged by the Pennsylvania Office of Attorney General, for allegedly conspiring to defraud the Pennsylvania Medicaid program, United States Attorney David Metcalf announced on Aug. 4 in Philadelphia.
Metcalf was joined at a news conference by Assistant Attorney General Colin McDonald of the Department of Justice’s National Fraud Enforcement Division; Pennsylvania Attorney General Dave Sunday; Scott Brady, Executive Director of the White House Task Force to Eliminate Fraud; Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services; T. March Bell, Department of Health and Human Services Inspector General; Wayne Jacobs, Special Agent in Charge of FBI Philadelphia; Stanley Rutkowski from HHS-OIG Philadelphia Regional Office; Timothy Flaherty from DEA Philadelphia; and Larry Arrow from IRS Criminal Investigation in Philadelphia.
“The great fraud against the American taxpayer takes many forms,” said U.S. Attorney Metcalf. “It is outrageous and unacceptable that anyone could steal money by billing nonexistent home care services for caregivers who were, in fact, dead, in prison, or trafficking drugs.”
Assistant Attorney General McDonald announced an expansion of the Fraud Division’s Northeast Health Care Fraud Strike Force to Philadelphia as part of this enforcement initiative. According to McDonald, “Home care funding exists to assist America’s elderly and most vulnerable — not to fund schemes in which aides claim be providing care while incarcerated or vacationing in Miami and Saudi Arabia.”
The indictments cover several alleged schemes involving fraudulent billing for home health services that were never provided or occurred while caregivers were otherwise occupied—including being incarcerated or traveling abroad—and involve payouts totaling millions of dollars over multiple years.
Pennsylvania Attorney General Dave Sunday said, “This criminal conduct is much more than someone ‘working the system’ — the impact is deep and wide-ranging, as every dollar diverted deprives someone in need of care.” CMS Administrator Dr. Mehmet Oz added, “Medicaid fraud robs hardworking taxpayers…CMS will continue partnering with law enforcement to shut down these scams while establishing new anti-fraud safeguards that flag criminal activity before the money ever leaves the building.”
Officials emphasized that all defendants are presumed innocent unless proven guilty.