Updated
Updated · WGAL Susquehanna Valley Pa. · Aug 4
DOJ Charges 19 in $4 Million Philadelphia Home Health Fraud, Expands Strike Force
Updated
Updated · WGAL Susquehanna Valley Pa. · Aug 4

DOJ Charges 19 in $4 Million Philadelphia Home Health Fraud, Expands Strike Force

3 articles · Updated · WGAL Susquehanna Valley Pa. · Aug 4

Summary

  • Nineteen defendants were charged in Philadelphia over more than $4 million in fraudulent Medicare and Medicaid home health claims, in what federal officials called a major healthcare fraud takedown.
  • Prosecutors said the schemes billed for care never provided, including services supposedly delivered while aides or recipients were incarcerated, hospitalized, overseas or working other jobs.
  • One defendant allegedly claimed over 64,000 impossible work hours and collected more than $1.2 million, including more than 1,100 days with over 24 hours billed; another logged 8,700 overlapping hours tied to $180,000 in claims.
  • A third suspect is accused of billing 1,300-plus hours for a recipient jailed on state drug charges, while another was recorded calling home health care “the best kept secret” after making about $500,000 in five years.
  • The department also expanded its Northeast Health Care Fraud Strike Force into Eastern Pennsylvania, adding Philadelphia to a federal-state effort to investigate and prosecute healthcare fraud.

Insights

With a nationwide freeze on new home health agencies, will this massive fraud crackdown inadvertently leave vulnerable patients without care?
How did government systems allow fraudsters to bill for more than 24 hours of care in a single day before being caught?
Can advanced data analytics finally outsmart the billions lost to medical billing scams, or are fraudsters already one step ahead?