Medicaid Brigade 

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Corrupt doctor with money in his pocket

A Pittsburgh, Penn., woman pleaded guilty in federal court to conspiracy to defraud the Pennsylvania Medicaid program. (Her rap sheet also included healthcare fraud and aggravated identity theft.) Tamika Adams, 45, was sentenced to prison, followed by supervised release, and a hefty restitution fee for her role in a lengthy healthcare conspiracy.

Adams was an employee of three companies in the home health care industry – Moriarty Consultants, Inc. (MCI), Activity Daily Living Services, Inc. (ADL), and Everyday People Staffing, Inc. (EPS). MCI, ADL, and another related company, Coordination Care, Inc. (CCI), were approved under the Pennsylvania Medicaid program to offer personal assistance services (PAS) to qualifying Medicaid recipients. (EPS may not have made it on the official provider list, but this entity was known to do “under the table” work for MCI, ADL, and CCI.)

Adams admitted that during her time of employment with these entities, she was a part of an elaborate conspiracy to defraud the Pennsylvania Medicaid program. Her plan was to steal millions of dollars in illegal Medicaid payments by falsifying service claims. Most of these services were never provided to the consumers identified on the claims. (Her scam was nothing new, just one of the oldest tricks in the Book of Medicaid Fraud.) Adams’ role in the conspiracy included fabricating timesheets to bump up the hours of in-home PAS care she provided. (She didn’t even show up, let alone provide the care listed).

Adams went on to admit that she paid kickbacks to one consumer. (This “consumer” just so happened to be her spouse at the time, and her bribe was meant to incentivize him to join in on the scheme.) Adams’ own father, Tony Brown, was even a part of this conspiracy. She would routinely use Brown’s name on the fabricated timesheets to submit for care of her then-spouse.  (She also concealed her co-habitation with her then-spouse, as he was one of her main “customers” for PAS, and this was a disqualifying circumstance for the Medicaid program.) 

This trio – Adams, her father, and her then-spouse would meet on the day that Brown was set to receive payment for the falsified care, and divide the proceeds. (Adams did acknowledge that the falsified claims she submitted to Pennsylvania Medicaid for “caring” for her then-spouse alone totaled over $250,000.) MCI, ADL, and CCI together collected tens of millions of dollars in Medicaid payments from these falsified service submissions. Out of all the home health service claims submitted; PAS payments accounted for the majority. (Conveniently, at the time, Adams was an employee.)  

Adams was sentenced to sixty-five months of imprisonment, followed by two years of supervised release, for her lengthy role in the Medicaid conspiracy. She was also ordered to pay restitution to the Pennsylvania Medicaid program (in the jaw-dropping amount of $445,131.67).

In total, sixteen defendants have been charged in connection with this investigation. Adams was the twelfth fraudster to enter a guilty plea. (We will continue to wait patiently for the verdicts of the remaining defendants. I think we can all guess the end of this story.)

Today’s Fraud of the Day comes from an article, “Pittsburgh Resident Sentenced to More Than Five Years in Prison for Conspiracy, Health Care Fraud, and Aggravated Identity Theft,” published by the United States Attorney’s Office (Western District of Pennsylvania) on December 1, 2021.

PITTSBURGH, Pa. – A resident of Pittsburgh, Pennsylvania, was sentenced in federal court for conspiracy to defraud the Pennsylvania Medicaid program, health care fraud, and aggravated identity theft, United States Attorney Cindy K. Chung announced today.

United States District Judge Cathy Bissoon sentenced Tamika Adams, 45, to sixty-five months of imprisonment, followed by two years of supervised release, for her role in a years-long conspiracy. Adams was also ordered to pay restitution to the Pennsylvania Medicaid program in the amount of $445,131.67.

 

 

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.