The Justice Department has indicted 19 people in Pennsylvania accused of submitting more than $4 million in false Medicare and Medicaid claims for fictitious home-health shifts. Prosecutors allege examples including aides billing while incarcerated, hospitalized, deceased or traveling abroad. Investigators say some defendants claimed implausible hours — including one case totaling over 64,000 billed hours and another with more than 8,700 overlapping hours. DOJ and FBI officials called the schemes deliberate fraud that diverts resources from patients.
DOJ Indicts 19 In Pennsylvania Over Alleged $4M Home-Health Billing Fraud
The Department of Justice building is shown in February in Washington, D.C. On Tuesday, the Justice Department announced it had indicted 19 people in Pennsylvania for alleged home healthcare fraud. File Photo by Bonnie Cash/UPI
The U.S. Department of Justice announced Tuesday that 19 people in Pennsylvania have been indicted for allegedly submitting claims for thousands of fictitious home-healthcare shifts, resulting in more than $4 million in false claims to Medicare and Medicaid.
Allegations and Examples
Prosecutors say the defendants include home health aides and owners of home health agencies. In multiple cases, aides are accused of billing for care they did not provide — including periods when they were incarcerated, hospitalized, deceased or physically outside the country.
In one set of allegations, two home health aides and two Medicaid recipients together accounted for more than $440,000 in fraudulent claims after aides purportedly billed for payable services while one aide was in prison and another was receiving inpatient care, the government said.
'The defendants' conduct was characterized by extraordinary greed,' the National Fraud Enforcement Division said in a press release.
In another case, a defendant is accused of claiming to provide services to as many as seven Medicaid recipients at once. On more than 1,000 occasions the person billed for providing care longer than 24 hours in a single day — prosecutors say that added up to more than 64,000 hours. A different aide allegedly logged more than 8,700 overlapping hours.
Assistant Attorney General Colin McDonald emphasized that these were not clerical mistakes: 'They involve supposed home health aides who billed the taxpayer for home care services but never actually provided those services — and supposed Medicare patients who conspired with other fraudsters to bill the taxpayer for completely unnecessary health services,' he said.
U.S. Attorney David Metcalf described a range of alleged abuses, including billing for aides who were dead, incarcerated or traveling abroad. Investigators also flagged social media evidence in at least one case, where a defendant posted poolside vacation photos while claiming to be on duty.
'Healthcare fraud is not a victimless crime. It undermines public trust and diverts critical resources from patients who need them,' said Wayne Jacobs, special agent in charge of the FBI's Philadelphia field office. He added that complex schemes like these require coordinated agency efforts to investigate and prosecute.
Impact and Next Steps
The indictment seeks to hold those accused accountable and to recover taxpayer dollars lost to the alleged fraud. The DOJ and its partners continue to investigate and pursue cases that target fraudulent billing practices that threaten the integrity of Medicare and Medicaid.
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