The DOJ Fraud Division, U.S. Attorney’s Office, and Pennsylvania Attorney General today announced criminal charges against 19 defendants, including owners and employees of home care companies, for their alleged participation in various fraud schemes involving over four million dollars in claims to Medicare and Medicaid.
The Pennsylvania Attorney General also announced a plea agreement involving the final defendant in a previously-charged 21 defendant case involving over $1.7 million in claims.
Assistant Attorney General Colin M. McDonald of the Justice Department’s National Fraud Enforcement Division, Dr. Mehmet Oz, Administrator for the Centers for Medicare & Medicaid Services, U.S. Attorney David Metcalf for the Eastern District of Pennsylvania, and senior federal and state officials hold a press conference announcing a significant health care fraud takedown and a new Anti-Fraud Initiative in the Eastern District of Pennsylvania.
To emphasize the scope of the fraud in California and New York Dr Oz notes, “the number one job in the entire state is personal care services.” (WATCH – prompted):
DOJ Press Release – […] The defendants’ conduct was characterized by extraordinary greed. In one case, the Pennsylvania Attorney General charged a purported home health aide who claimed to have provided services to up to seven Medicaid recipients at once. On over 1,100 occasions, the defendant allegedly claimed to have provided care for more than 24 hours in a single day, totaling over 64,000 hours that could not have been worked.
As alleged, Medicaid paid over $1.2 million as a result of the scheme. Another defendant who was charged in today’s announcement, a purported aide, claimed to have worked over 8,700 overlapping hours. As alleged, there were nearly 400 days on which the defendant claimed to be working for more than 24 hours in a day. The defendant allegedly caused over $180,000 in loss to Medicaid. In another case, a defendant was charged who claimed to have provided over 1,300 hours of home care services for a Medicaid recipient who was himself incarcerated on state drug charges. A defendant in one case was captured on a recorded conversation stating that “this home health care is the best kept secret . . . I made a buck plus [each of] the last five years, that’s, that’s a half a million dollars . . . I ain’t checking on nobody.” (read more)
Excellent! Now do election fraud.
Paging judge bo ass burg
We don’t have a national debt problem, we have a national fraud problem.
And it all goes back to tooooo much gvt.
Kudzu strangles everything in it’s path.
With all the fraud being reported, fully half of the entire federal budget must be consumed by fraud, waste, and abuse. These 19 defendants can only be but a drop in the bucket for just this one particular kind of fraud. Small numbers of prosecutions here and there are not going to fix this. There needs to be significant reform of that program, if not just get rid of it altogether.
I think one of the problems is that while Medicaid was initiated in the 1960s as a 50/50 federal/state matching program, the way the funding was designed is that it has evolved (or devolved) into approximately a 90/10 federal/state match today and is getting worse. Plus, what it covers keeps expanding. The states are administering it, but hardly funding it. The original formula needs to be restored. The states won’t care what happens until their own budgets begin paying for most of it, and even then they might not care.
I’m glad they are going after these crimes. However, none of that money will ever be recovered. It is gone forever.
The real cure will be preventing these disbursements. I for one would rather read about xxx millions of dollars that were NOT paid out to these criminals AND the perpetrators have been arrested awaiting trial for fraud.
The Democrat cartel in California, alone, stole hundreds of billions of dollars over the past five years.
Excellent idea that would change behavior quickly!
“I think one of the problems is that while Medicaid was initiated in the 1960s as a 50/50 federal/state matching program, the way the funding was designed is that it has evolved (or devolved) into approximately a 90/10 federal/state match today and is getting worse. Plus, what it covers keeps expanding. The states are administering it, but hardly funding it. The original formula needs to be restored. The states won’t care what happens until their own budgets begin paying for most of it, and even then they might not care.”
But don’t worry, my friends. The elections are secure!
Election integrity is managed by the same government bureaucracy that monitors and approves Medicaid claims. Except every once in awhile they’ll bust a Medicaid fraudster.
We need higher taxes, we’re not keeping pace with the fraud.
“We need higher taxes, we’re not keeping pace with the fraud.”
Democrats:
“Good point, tax the rich……and everyone is rich (but us, we won’t tax*US*!)!!!”
This country runs on fraud. Who knows how many BILLIONS of dollars goes to fraud. Stolen from taxpayers. Printed by Treasury. Borrowed from foreign governments. A good chunk of that to political groups with the FULL KNOWLEDGE of the politicians. Most (not all) don’t want it to stop, just look like they are trying to stop it.
California’s entire economy is built on Fraud and looting the Federal Govt’…… Notice the shifts in the money flow. As Vance and Trump shutdown their Healthcare fraud….. they shifted to the new Commie 5% tax on Billionaires to fill part of the hole…. LMAO
Another perfect example of the economic truism that when something is subsidized, more of that something is demanded and quality diminishes. To paraphrase: good government, to the extent that it ought to be allowed, is that which is allowed to govern least.
Now, I do wonder about the claims data-entry systems! They should be able to detect and immediately flag questionable claims and providers before payment is tendered. For example, did you book more than 24 hours in a day? Do the time ranges impossibly overlap?
Being a computer geek, I can easily envision a batch process that is run as the first step of preparing a batch of claims for disbursement. It should be looking for typographic errors, and it should be looking for basic fraud. The questionable batches should then be flagged for human review.
If the system that is in place allowed this sort of fraud to take place, and did so for years, then obviously there is a complete lack of reasonable financial controls in the disbursements process.
Last year DOGE was trying to help institute the very “checks on claims” you describe.
The Courts and Congress refused to allow it for “privacy and personal data security reasons”. The same reasons being used to stop election security reforms, in the Courts and congress.
Court orders continuation of fraud.
Our Democracy.
I find it hard to believe that in this day and age of AI that this shit happens all the time. There is nothing in place to send up a red flag That a person is charging way way out of line? Something is not passing the smell test here. And the best part is that we never recover the stolen money back.
The payout system is built on trust.
Since it’s proven we are not a high trust society, the solution is to immediately shut down the payment system until safeguards and accountability are put into place. If a program is unable to be guarded, such as self-report home healthcare, than that program must be eliminated.
The amount of fraud in this country…and the others in the ‘global realm’, is astounding. I can’t wrap my head around these ‘heists of taxpayer money’. Am feeling like thieves outnumber the honest working person.
Everybody wants to get in on the act. And with no apparent oversight, is it any wonder. The examples provided of this case are so ridiculously obvious that these overpayments are just being rubber stamped. The individuals who are supposed to administer the medicare program should be jailed and heavily fined also.
(reposting this article for the umpteenth time since 2018)
In 2018 I bookmarked this article on Somalis flying out of Minneapolis–Saint Paul International Airport weekly with suitcases filled with millions of dollars stolen from American public assistance programs.
“Millions of dollars in suitcases fly out of MSP, but why?”
“Published May 14, 2018 2:00pm CDT”
“On the morning of March 15, Fox 9 chased a tip about a man who was leaving the country. Sources said he took a carry-on bag through security that was packed with $1 million in cash. Travelers can do that, as long as they fill out the proper government forms.”
“Fox 9 learned that these cloak-and-dagger scenarios now happen almost weekly at MSP. The money is usually headed to the Middle East, Dubai and points beyond. Sources said last year alone, more than $100 million in cash left MSP in carry-on luggage.”
https://www.fox9.com/news/millions-of-dollars-in-suitcases-fly-out-of-msp-but-why
Of the hundreds of Somalians in Minnesota that stole 9 billion $$$ by fraud, only 19 have been arrested and charged with the crime…
How evil will the evil get?
We are seeing horror we never thought we’d see.
When obiden installed all the corrupt judges, so fast, they did what we need to do in reverse, or our society is gone.
President Trump is dismantling their $$$$. Will it dismantle the anarchy, the anti America judges? We pray it will.
Against the rules and off topic. What’s with the new conservative treehouse logo? Not loving it. FWIW
Names
https://www.justice.gov/usao-edpa/pr/dozens-charged-health-care-fraud-federal-and-state-cases-involving-576-million
Peanuts compared to Minnesota which has yet to see anyone prosecuted with billions and billions being stolen by foreigners and looting local politicians all the way to the top in Minnesota including the AG Nation of Islam member.
“WE ARE COMING FOR YOU”
Yep, if you are “low-hanging fruit”, but if you are a big wig politician that permitted the fraud, you are home free…
Limit the government and limit the fraud. It’s that simple.
California fraud will surpass all other fraud discovered to date.
Retired Magistrate here: I am glad to see that people are finally recognizing that white collar crime is really a crime and numerous people are injured by it.
Many years ago I started the Ohio Department of Insurance Fraud Division, and we uncovered a huge mortgage fraud scam in Cleveland, Ohio and after about 4 years of investigation we were able to get a conviction and jail time against the perpetrators. Unfortunately the last day in office, Ohio Governor Richard Celeste, a Democrat. pardoned the perpetrators because he didn’t think that white collar crime was really a crime; it was no big deal.
Of course it was a big deal to the home owners who lost everything due to the fraud, but that didn’t matter to Celeste. This was back in the late 1980’s and early 1990’s when many individuals didn’t think any type of insurance fraud was any big deal either. Over the last decade that philosophy has been proven wrong. Glad to see that people are stating to be held accountable.
Tip of iceberg. Every county, every state. Some more than others. Guess we have to start somewhere. Wait until they get to the hospitals where a city municipality and or county has part ownership. It is going to be so ugly.
With Ai now it should be able to easily spot fraud…
There not even complicated schemes and lengthy money trails. Just blatant lies that a nine year old would see through.
I’m sick and tired of paying taxes for this kind of crap.
Somalis again?
In state or local gov’t, the office of Attorney General is traditionally the best place to launch a successful political career.
How fortunate that the Trump Administration has spotlighted a fat, juicy target for Attorneys General all over the USA to target.
If you’re an AG who aspires to higher office, what could win greater voter approval than to successfully prosecute fraud & corruption that wastes public tax money?
Drop in a bucket