New Year, Same Shenanigans

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Calculator and stethoscope on paperwork

Many individuals make New Year’s resolutions related to self-improvement. This was apparently not the case for a woman from Pittsburgh, Pa., who was sentenced for her role in a Medicaid scam that lasted for more than five years. (Studies show that only about 20 percent of those who set goals at the start of a new year actually achieve them. Apparently, if today’s fraudster had set a goal to stop defrauding others, she fell within the 80 percent who fail to achieve their New Year’s resolutions each year.) Today’s fraudster was sentenced for conspiracy to defraud the Pennsylvania Medicaid program and commit health care fraud.

Terra Dean admitted to participating in a conspiracy that cost Pennsylvania Medicaid millions of dollars in losses. Between 2011 and 2017, the woman worked for Moriarty Consultants, Inc. (MCI) and other associated home health entities. (Here’s a little foreshadowing: did anyone catch the link to the name ‘Moriarty,’’ or the criminal mastermind Sherlock Homes refers to as the ‘Napoleon of crime’?)

The additional companies Dean was employed by include Activity Daily Living Services, Inc. (ADL), Coordination Care, Inc. (CCI), and Everyday People Staffing, Inc. (EPS). These providers were approved by Pennsylvania Medicaid to offer home health and other personal assistance services (PAS) to Medicaid beneficiaries. Services offered by these companies included service coordination, non-medical transportation, among other caregiving services. (The only one helped in this scheme was Dean and her co-conspirators.)

MCI, ADL, and CCI submitted and received $87,000,000 in claims between January 2011 and April 2017. More than $80,000,000 of these claims were submitted for PAS services that the companies fraudulently claimed their employees had carried out on behalf of Medicaid beneficiaries. Dean admitted that the majority of these claims were fraudulent and that she was a part of a vast conspiracy to defraud the Pennsylvania Medicaid program out of millions of dollars. (I bet that was not easy for this fraudster to admit. She most likely ran out of lies to cover her tracks.)

The fraudulent claims were made for services that had either never been provided to the beneficiary or for which there was fabricated evidence to support the claim. Dean and other health care professionals fabricated timesheets to reflect the fraudulent claims. These timesheets falsely asserted that Dean provided home health services to qualifying Medicaid beneficiaries. (They were getting paid by their companies to lie through their teeth to insurance agencies.)

Furthermore, fraudulent claims were submitted using the names of fictitious employees. Dean listed the names of close friends and relatives in the place of home health aides. She also illegally paid kickbacks to beneficiaries in exchange for their cooperation in the billing scheme.

While the overall scheme cost Pennsylvania Medicaid millions, Dean was personally responsible for only about $150,000 in losses. Consequently, she was sentenced to four years of probation which includes six months of home detention. (Staying at home doesn’t seem much different than what the rest of us are doing right now.) She was also ordered to pay restitution to the Pennsylvania Medicaid program in the amount of $94,101.55.

More than twelve additional defendants have pleaded guilty for their roles in this conspiracy. The Department of Justice relies on its federal and state partners as well as tips from the public to detect and prosecute Medicaid fraud. Suspected Medicaid fraud can be reported by calling 1-800-447-8477 or via email to HHSTips@oig.hhs.gov.

Today’s Fraud of the Day comes a Department of Justice press release, “Pittsburgh Resident Sentenced in Multi-Million Dollar Health Care Fraud Conspiracy,” published on December 9, 2020.

PITTSBURGH, Pa. – A resident of Pittsburgh was sentenced in federal court for conspiracy to defraud the Pennsylvania Medicaid program and health care fraud, United States Attorney Scott W. Brady announced today.

United States District Judge Cathy Bissoon sentenced Terra Dean, 46, to four years of probation, including six months of home detention for her role in a years-long conspiracy. Dean was also ordered to pay restitution to the Pennsylvania Medicaid program in the amount of $94,101.55.

 

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Larry Benson
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.