MM Curator summary
[MM Curator Summary]: The $400k+ fraud involved multiple companies and members taking money for use of their IDs to steal from PA Medicaid.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
PITTSBURGH, Pa. – Two residents of Pittsburgh and a resident of Georgia were sentenced in federal court for conspiracy to defraud the Pennsylvania Medicaid program and related offenses, United States Attorney Cindy K. Chung announced today.
During sentencing hearings on June 28 and June 29, 2022, United States District Judge Cathy Bissoon sentenced Tiffhany Covington, 45, of Pittsburgh, to fifteen months’ imprisonment; Luis Columbie-Abrew, 36, of East Point, Georgia, to three years’ probation, including twelve months of home confinement; and Julie Wilson, 51, of Pittsburgh, to three years’ probation, including six months of home confinement. Covington, Columbie-Abrew, and Wilson were also ordered to pay restitution to the Pennsylvania Medicaid program totaling $245,376.26, $164,799.48, and $2,083.36, respectively. All three defendants previously pleaded guilty to conspiracy to commit health care fraud. Columbie-Abrew and Wilson also pleaded guilty to health care fraud, with Columbie-Abrew pleading guilty to an additional charge of aggravated identity theft.
During their plea hearings, each defendant admitted that they were employees of one or more of four related entities operating in the home health care industry—Moriarty Consultants, Inc. (MCI), Activity Daily Living Services, Inc. (ADL), Coordination Care, Inc. (CCI), and Everyday People Staffing, Inc. (EPS). MCI, ADL, and CCI were approved under the Pennsylvania Medicaid program to offer certain services to qualifying Medicaid recipients (“consumers”), including personal assistance services (PAS), service coordination, and non-medical transportation, among other services. Between 2011 and 2017, the defendants admitted that they participated in a wide-ranging conspiracy to defraud the Pennsylvania Medicaid program for the purpose of obtaining millions of dollars in illegal Medicaid payments through the submission of 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. The Court was further advised that the defendants conspired with, among others, Arlinda Moriarty, the owner of MCI, ADL, and EPS; Daynelle Dickens, the owner of CCI and Arlinda Moriarty’s sister; various office workers at the companies, including Tamika Adams, Tony Brown, Terra Dean, Larita Walls, Keith Scoggins, and Tia Collins; and caregivers (“attendants”) at MCI, including Tionne Street and Autumn Brown. To date, each of these co-conspirators have also pleaded guilty for their roles in the conspiracy.
As part of the conspiracy, the defendants each admitted that co-conspirators fabricated timesheets to reflect the provision of in-home PAS care they provided to consumers but that, in fact, never occurred. In addition, certain co-conspirators, including Covington and Columbie-Abrew, stopped using their own names as the attendant on timesheets and instead used the names of “ghost” attendants, some of whom permitted their names to be used in exchange for a kickback of resulting fraudulent salary payments. The defendants also admitted that certain co-conspirators submitted false timesheets for PAS care they never provided during times when they were actually working at other jobs or living out of the area. In some cases, as the defendants acknowledged, Medicaid claims were submitted for PAS care that purportedly occurred while consumers were hospitalized, incarcerated, or deceased, and in other instances, co-conspirators paid kickbacks to consumers in exchange for the consumers’ agreement to participate in the submission of fraudulent timesheets in support of Medicaid claims. Indeed, Columbie-Abrew specifically admitted causing the submission of hundreds of thousands of dollars of Medicaid claims for purported care of consumers who lived in the Pittsburgh area, despite the fact that he—as the purported attendant—lived several states away in Georgia.
The defendants also admitted that Arlinda Moriarty directed co-conspirators, including Covington, to bill the maximum allowable PAS and service coordination hours for consumers to maximize profits and to ensure that the state did not require MCI, ADL, and CCI to forfeit underutilized consumer hours. To that end, Wilson acknowledged that, at Moriarty’s behest, she collected information about consumers who had “unused” PAS care hours—that is, hours of authorized PAS care that had not been performed and, as a result, had not been billed to Pennsylvania Medicaid. In response, Wilson would provide lists of such consumers and their “unused” hours to Moriarty and Dickens. Moriarty, in turn, would direct Wilson to submit false claims, in bulk, for some or all of the “unused” hours—without the relevant consumers’ knowledge or consent. Wilson further admitted that she would then send Moriarty a list of the “unused” hours Wilson had billed and that required the creation of back-dated timesheets to document the purported care. Rampant document fabrication also occurred during the course of state audits of the Moriarty-related entities.
Assistant United States Attorney Eric G. Olshan and Special Assistant United States Attorney Edward Song are prosecuting this case on behalf of the government. The Federal Bureau of
Investigation, Pennsylvania Office of the Attorney General – Medicaid Fraud Control Unit, Internal Revenue Service – Criminal Investigation, U.S. Department of Health and Human Services – Office of Inspector General, and United States Postal Inspection Service conducted the investigation of the defendants.
Clipped from: https://www.justice.gov/usao-wdpa/pr/three-more-defendants-sentenced-their-roles-wide-ranging-medicaid-fraud-conspiracy