Federal and state officials, including Mehmet Oz, head of the Centers for Medicare and Medicaid Fraud, and Pennsylvania Attorney General David Sunday were in Philadelphia Tuesday to highlight efforts to combat the persistent problem of Medicaid billing fraud in home care.
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During a news conference in Center City, officials outlinedPennsylvania cases involving a personal care assistant who billed Medicaid 1,000 times for more than 24 hours of work in a single day, another who billed for helping his father in South Philadelphia while being arrested in Chester, and an agency that billed Medicaid $225,000 for services provided by an aide who was dead.
Federal and state prosecutors used the occasion to announce charges against 18 people and one agency in mostly unrelated cases for defrauding Pennsylvania’s Medicaid program of $4 million by billing for home care services they did not provide. The alleged fraud occurred roughly over the past five years.
The alleged fraud in these cases filed over the last two weeks is tiny compared to the size of the program. Pennsylvania spent $8.1 billion on home care services last year, up from $2.3 billion in 2020, when the program expanded and thousands more people started getting paid to provide home care.
“Used properly by honest citizens, the program allows those with physical ailments to be cared for by those they trust the most,” said Colin McDonald of the justice department’s National Fraud Enforcement Division. “But infiltrated by greedy and deceitful opportunists, this program becomes a money tree, a gravy train for criminal fraudsters.”
The U.S. Department of Justice shared details on six new cases. The Pennsylvania Attorney General recently filed five new cases.
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The biggest case involved $1.5 million in billings from a personal care assistant registered with 13 agencies who more than 1,000 times charged Medicaid for more than 24 hours in a single day, attorney general David Sunday said. On one occasion the aide billed for 126 hours in a single day, Sunday said.
Federal prosecutors charged Benevolent Home Health Care with billing 600 times in 13 months for a personal care aide who was dead. That case originated during the arrest of the husband of one its owners on drug-trafficking charges, said David Metcalf, U.S. Attorney for the Eastern District of Pennsylvania.
As the man was being arrested, he told agents from the Drug Enforcement Agency that he had to clock out of his shift as a home care aide, even though he wasn’t providing services. When asked about it, according to Metcalf, he said: “Everybody is doing this. If that’s a problem, you’d have to arrest the whole city,”
Attorneys for Benevolent’s owners, Khaleehah Williams and Saleemah Davis, said they had no comment.
In other cases, defendants billed for providing services while they were in prison, working at one of Philadelphia’s sports stadiums, or vacationing in Saudi Arabia, Jamaica, and Colombia.
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