Home-Health Fraud

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People who qualify for Medicaid’s home healthcare coverage are some of the most vulnerable among us. They are impoverished or disabled and count on home-health workers to help them with basic needs. But that doesn’t stop some people from stealing from the program and not giving patients services they are due.

That’s the case with a Pennsylvania-based fraud ring where a seventh person has pleaded guilty to defrauding the commonwealth’s Medicaid program.

The 48-year-old Pittsburgh woman is among 16 home healthcare workers indicted on charges of defrauding the system of about $80 million.

For her part, the woman pleaded guilty to defrauding the program of about $70,000. (Guaranteed she’ll have to pay that back). The woman was involved in the conspiracy from January 2011 through April 2017 when she fabricated time sheets for four home-health companies she worked for during that time, federal prosecutors said. She is scheduled to be sentenced in March.

The defendants submitted fraudulent claims for services that were never provided to the consumers identified on the claims, or for which there was insufficient or fabricated documentation to support the claims, prosecutors said.

Pennsylvania loses millions of dollars each year by paying for fraudulent claims, according to the Medicaid Fraud Hotline (888-742-7248). The state now offers rewards of more than $1 million to those who report potential fraud to its hotline.

Today’s Fraud of the Day is based on the article, “7th defendant pleads guilty in alleged $80 million Medicaid fraud case,” published by The Tribune-Review on Nov. 26, 2019.

A Pittsburgh woman pleaded guilty to federal charges of Medicaid fraud and conspiracy.
Tionne Street, 48, was accused of defrauding Medicaid for about $70,000 and was one of about 16 people who were indicted on the alleged conspiracy involving about $80 million in overall fraud.

Street is the seventh person to enter a guilty plea.

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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.