State and federal agencies say they are expanding their fight against home healthcare fraud in Pennsylvania. NBC10 Responds Reporter Valeria Aponte Feliciano has the details.
More than a dozen defendants, including a home health agency, are facing criminal charges following an investigation into healthcare fraud in Pennsylvania, officials announced Tuesday
During a news conference, state and federal officials announced that 19 defendants had been charged in connection with healthcare schemes that targeted Pennsylvania’s Medicaid program, which resulted in more than $4 million in fraudulent claims
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“The great fraud against the American taxpayer takes many forms,” said U.S. Attorney David 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 for the National Fraud Enforcement Division Colin McDonald said 18 of the 19 defendants were charged in the last 12 days
“Used properly by honest citizens, the program allows those with physical ailments to be cared for by those they trust the most, but infiltrated by greedy and deceitful opportunists, this program becomes a money tree, a gravy train for criminal fraudsters,” McDonald said
According to McDonald, the criminal cases announced Tuesday were not the result of paperwork mistakes or good-faith accounting errors. Instead, he said, those involved billed Medicaid for home care services that were never actually provided
“We charged two home health aides and two purported patients with causing over $400,000 in false claims to Medicaid for services the aides supposedly performed when they were actually hospitalized, working at other jobs and even in jail,” McDonald said. “Yes, the allegations include a scheme that billed taxpayers for home care services provider provided when the person supposedly doing that work was sitting behind bars. That, of course, is not health care. It’s just pure theft.”
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McDonald said another case involves a father and son in which the father is accused of working as a rideshare and food delivery driver during the times he was supposedly receiving in-home care
“On another occasion, on the very day that the son billed Medicaid for a full day of in-home care for his father. The father was not home at all. He was in a courtroom watching a different relative get sentenced for defrauding this same program,” he said
Another case involves Sean Murray, who prosecutors said is accused of billing Medicaid for home care services that were never provided. In one example, officials allege Murray reported about 30 hours of care in March 2024 while he was on a Norwegian Cruise Line cruise
“In a jail call that was recorded in August 2024, Sean Murray boasted about how easy a racket it was. He said, this home healthcare was the best kept secret,” Metcalf said
NBC10 Responds reached out to Murray’s attorney regarding the allegations and charges against her client
“We look forward to receiving the discovery in the case and defending it accordingly. It would be premature for me to comment on the substance of the case at this early stage. Mr. Murray enjoys the presumption of innocence, and we intend to pursue his defense aggressively,” Attorney Gina Amoriello said
Officials said verifying that care was actually provided can be challenging, especially when caregivers don’t need a medical license — something that federal prosecutors has created an opportunity for fraud
According to Metcalf, billing under the state’s home care program has skyrocketed
In 2019, a year after the program was implemented, providers billed $120 million for services. Last year, that figure jumped to $8 billion — more than 66 times higher
“This is not the reflection of supply and demand. It is a reflection of the systematic exploitation of a vulnerable program by fraudsters,” Metcalf said
During the news conference, officials also announced that the Northeast Strike Force team is expanding to Philadelphia, and will included fraud prosecutors to further “root out the fraud” in the state
“This district has a long-standing tradition of not only prosecuting egregious frauds like the ones charged today, but also a history of excellent corporate enforcement, both civilly and criminally,” McDonald said
