Federal authorities have charged 19 people in what prosecutors describe as a sweeping Medicaid home health care fraud scheme that allegedly siphoned more than $4 million from taxpayer-funded health care programs. The announcement came Tuesday as the Department of Justice unveiled a major expansion of its Northeast Health Care Fraud Strike Force into Philadelphia, signaling a renewed focus on rooting out fraud in one of the nation’s largest Medicaid markets.
According to the Justice Department, the defendants include home health care agency owners, employees, home health aides and Medicaid recipients accused of participating in multiple schemes designed to fraudulently bill Medicare and Medicaid for services that were either never provided or were impossible to have occurred. Prosecutors allege the schemes collectively generated more than $4 million in false claims submitted to government health care programs.
Officials said investigators uncovered a wide variety of alleged fraud. In several cases, home health aides are accused of billing Medicaid for caring for patients while they were actually incarcerated, hospitalized, working another job or even traveling outside the United States. Other defendants allegedly submitted timesheets showing overlapping work schedules or more than 24 hours of patient care in a single day, something prosecutors say is physically impossible.
One particularly notable allegation involves a Medicaid recipient who reportedly claimed to require extensive in-home personal care services while simultaneously working as a carpenter. Prosecutors argue that the employment records directly contradicted claims that the individual required around-the-clock assistance, allowing investigators to identify the alleged fraud.
Federal authorities also allege that one home health care company and its owners submitted false electronic clock-in and clock-out records in order to receive Medicaid reimbursements for services that were never actually performed. The Justice Department says these types of fraudulent billing practices not only waste taxpayer dollars but also divert resources away from patients who legitimately need home health services.
The criminal cases coincide with the creation of a new Health Care Fraud Strike Force office in the Eastern District of Pennsylvania. The expansion will pair prosecutors from the Justice Department’s National Fraud Enforcement Division with the U.S. Attorney’s Office for the Eastern District of Pennsylvania, while working alongside the FBI, the Department of Health and Human Services Office of Inspector General, the Drug Enforcement Administration and additional federal and state law enforcement agencies.
In announcing the initiative, the Justice Department said Philadelphia has a long history of aggressively pursuing health care fraud, and officials believe the expanded strike force will provide additional resources to investigate increasingly sophisticated schemes involving shell companies, fraudulent billing operations and organized criminal networks seeking to exploit Medicare and Medicaid.
Pennsylvania Attorney General Dave Sunday also highlighted a related milestone, announcing that the final defendant in an earlier 21-person Medicaid fraud investigation entered a plea agreement. That previous case involved more than $1.7 million in fraudulent claims, underscoring what authorities say has been a persistent pattern of abuse within portions of the home health care industry.
The charges announced Tuesday remain allegations, and all defendants are presumed innocent unless and until proven guilty in court. If convicted, many of those charged could face significant prison sentences, financial penalties and restitution orders.
Justice Department officials said the Philadelphia expansion reflects a nationwide effort to strengthen oversight of taxpayer-funded health care programs and crack down on fraud that drains billions of dollars from Medicare and Medicaid each year.
