Federal and Pennsylvania officials announced a major health care fraud enforcement action Tuesday, charging 19 people accused of schemes involving more than $4 million in allegedly fraudulent Medicaid claims.
The cases involve allegations that home health aides and Medicaid recipients submitted false claims for services that were not provided, including claims made while workers were allegedly hospitalized, incarcerated, working other jobs, or traveling outside the country.
Officials also announced an expansion of an anti-fraud strike force into Philadelphia as part of an effort to investigate additional cases.
Colin McDonald, assistant attorney general for the Department of Justice’s (DOJ) National Fraud Enforcement Division, said the defendants were accused of using Medicaid improperly by submitting claims for services that investigators say did not occur.
McDonald said investigators believe the cases involved deliberate attempts to obtain Medicaid payments for services that were never provided, rather than simple billing mistakes.
One case involved two Pennsylvania home health aides who prosecutors said submitted more than $400,000 in fraudulent claims for services they allegedly did not provide, NBC Philadelphia reported.
Officials said the aides submitted time records while they were hospitalized, working other jobs, or incarcerated.
Pennsylvania Attorney General Dave Sunday announced that two southeastern Pennsylvania women, Ashley Griffin and Yolanda Wright, were charged with felony Medicaid fraud, theft by deception, and conspiracy.
Prosecutors allege Griffin submitted nearly $1.5 million in Medicaid reimbursements for work that was not performed, while Wright allegedly assisted by submitting some time entries on Griffin’s behalf, according to NewsNation.
Authorities said Griffin submitted time records exceeding 24 hours of work in a single day on more than 1,000 occasions, including one instance where she allegedly reported 126 hours worked in one day.
Officials said the alleged conduct deprived Medicaid and intended care recipients of funds meant for legitimate services.
Other cases announced by officials involved allegations against Medicaid recipients and their caregivers.
Prosecutors said one recipient allegedly received extensive home health assistance while also working as a carpenter.
Another case involved a father and son, with officials alleging the father was engaged in outside activities during periods when in-home care was billed to Medicaid.
Officials also described additional allegations involving defendants accused of billing Medicaid while participating in unrelated activities.
U.S. Attorney David Metcalf said investigators found cases involving alleged fraudulent claims made while individuals were traveling, incarcerated, or engaged in other activities instead of providing or receiving reported services, CBS News reported.
The investigation comes as Pennsylvania officials and federal authorities expand efforts to combat Medicaid fraud through the Northeast Strike Force.
The initiative will expand into Philadelphia and include additional fraud prosecutors from the National Fraud Enforcement Division and the U.S. Attorney’s Office for the Eastern District of Pennsylvania.
McDonald said the expansion is intended to strengthen enforcement efforts against fraud targeting health care programs.
Officials noted that home health care programs are designed to allow qualified caregivers to assist people with medical needs while helping them remain in their communities rather than requiring institutional care.
Pennsylvania spends billions of dollars annually on home health care, making Medicaid fraud investigations a significant focus for state and federal officials.
The defendants charged in the latest cases will face court proceedings, and the allegations remain unproven unless established in court.
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