Fighting Medicaid Fraud and Abuse

April 3, 2025

Fighting Medicaid Fraud and Abuse
 
Lately, discussions around government waste, fraud and abuse have been prominent in the news, especially following the establishment of the Department of Government Efficiency (DOGE) by President Donald Trump at the federal level. While DOGE has been actively revealing instances of waste, fraud, and abuse within the federal government, similar issues are also prevalent at the state level.

Attorney General Dave Sunday’s Medicaid Fraud Team recently announced it recovered more than $11.3 million in misused Medicaid funding in fiscal year 2024. A federal annual report ranked Pennsylvania first in the nation for the number of Medicaid fraud charges filed against individuals and third in convictions secured.

The Medicaid Fraud Team prosecutes those who defraud the program through unlawful billing or failure to provide services. It also prosecutes those who neglect or abuse Pennsylvanians dependent upon their care and those who financially exploit older adults or care-dependent persons.

The Attorney General’s Office detailed a few of the Medicaid fraud cases it’s been prosecuting recently. For example, a Licensed Practical Nurse from Philadelphia County pleaded guilty last month to Medicaid fraud and theft by deception for reporting nearly 2,000 hours of nursing services that she could not have provided because investigators determined she was billing for caring for two different people at the same time or was traveling outside of the state or country at the time. She also owned a personal care agency through which she billed for fraudulent personal care services that her employees, including her sister, could not have provided because they, too, were traveling outside of the state or country. She will serve probation and was ordered to pay more than $96,000 in restitution.

In another case, a 63-year-old from Philadelphia County was charged with accusations of Medicaid fraud, theft by deception and tampering with public records regarding claims she made for personal care services for a person who was deceased. She allegedly received more than $33,000 in payments from Medicaid-funded managed care organization AmeriHealth for services that were alleged to have never been provided.

In Delaware County, a 24-year-old man pleaded no contest to Medicaid fraud, and was sentenced to 6 to 23 months in prison and two years of consecutive probation. He submitted more than 400 fraudulent hours for personal care he was alleging to provide to a patient who was actually hospitalized. He was ordered to pay $9,232 in restitution. 

Our Medicaid program exists to provide limited-income and vulnerable populations with access to health care. Medicaid fraud is not a victimless crime. It takes away vital services from folks in need.

I’m thrilled our attorney general and his team are doing their part to stop Medicaid fraud, and I will keep working to support all efforts to cut back on waste, fraud and abuse here in Pennsylvania.

Here are some additional news topics and reminders I would like to share.

Grant Workshop Scheduled

For local governments and nonprofit organizations, applying for grants can be complicated. Senate President Pro Tempore Kim Ward and I aim to make it easier! Join us Wednesday, April 16, from 10 a.m. to 2 p.m. at the Delmont Fire Hall, 2360 State Route 66, Delmont, to hear from several professionals in this field. RSVP by calling 724-387-9113.

Voter Registration Deadline May 5

Pennsylvanians who are not already registered to vote but wish to participate in the May 20 municipal primary election should be sure to register no later than Monday, May 5. 

To be eligible to vote in the primary, you must be a citizen of the United States for at least one month before the election; a resident of the election district in which you register to vote for at least 30 days before the primary; and at least 18 years of age on or before the date of the primary.

Under state law, only voters registered as Republicans or Democrats may vote for candidates in the primary election.
Citizens may register to vote online or visit your county voter registration office. 

Voters who prefer to vote by mail-in or absentee ballot have until May 13 to apply for the ballot and until 8 p.m. on May 20 to return it.


Representative Jill Cooper
55th Legislative District
Pennsylvania House of Representatives
Media Contact: Jordan Frei
724.875.8450
jfrei@pahousegop.com
RepJillCooper.com / Facebook.com/RepJillCooper