19 Charged in $4M Pennsylvania Home Health Care Fraud Schemes

Nineteen people have been charged in connection with alleged schemes that fraudulently billed Pennsylvania’s Medicaid program more than $4 million for home health care services, federal and state authorities announced Aug. 4.

The defendants, including home care company owners, home health aides and Medicaid recipients, were charged with health care fraud and other related offenses, according to the U.S. Attorney’s Office for the Eastern District of Pennsylvania. Prosecutors said the schemes involved false billing records, overlapping shifts, paying kickbacks to clients, and fraudulent clock-in and clock-out entries to collect Medicaid payments.

Some home health aides allegedly sought reimbursement for care they purportedly provided while they were in jail, hospitalized, out of the country, working other jobs or otherwise unavailable to assist patients, according to the Department of Justice.

Federal authorities also described recurring patterns of “impossible work hours,” including one case in which a home health aide allegedly claimed to provide care for over 24 hours in a day on more than 1,100 occasions. Prosecutors said the aide billed for more than 64,000 hours “that could not have been worked,” resulting in over $1.2 million in Medicaid payments.

“The great fraud against the American taxpayer takes many forms,” U.S. Attorney David Metcalf said in a statement. “It is outrageous and unacceptable that anyone could steal money by billing nonexistent home care services for caregivers who were, in fact, dead, in prison, or trafficking drugs.”

Health Aides Accused of Billing Medicaid While in Jail, Hospitalized or Working Other Jobs

Prosecutors charged several Philadelphia-area home health aides and Medicaid recipients.

One indictment charges Joseph Pizzo, 47, and Tiziana Taormina, 52, with conspiracy and health care fraud. Prosecutors alleged that Taormina submitted claims for home care services while Pizzo was incarcerated and while he was working in construction, leading to at least $160,000 in Medicaid payouts.

A separate indictment accused Donna Romsteadt, 63; Alyssa Cuculino, 27; Louise Israel, 46; and Elexis Cuculino, 51, of similar health care fraud offenses. According to prosecutors, Alyssa Cuculino and Israel were aides and Romsteadt and Elexis Cuculino were Medicaid recipients.

Alyssa Cuculino billed for home care services during periods when she was working another job or hospitalized, while Israel allegedly submitted claims while in jail, according to the indictment. Prosecutors said the scheme resulted in about $445,000 in fraudulent payments.

Authorities also charged Albert Coccia Jr., 56, and his son, Santino Coccia, 28, alleging Santino Coccia billed Medicaid for services he claimed to provide to his father while working as a ride-share and food-delivery driver. Prosecutors said the alleged fraud generated more than $211,000 in claims.

Prosecutors Allege Overseas Travel, Deceased Employees

In another case, prosecutors alleged that Sean Murray, 58, billed Medicaid about $400,000 for home care services that were not provided while he was at a gym, traveling, visiting a massage parlor or selling drugs. Authorities accused him of paying kickbacks to clients to facilitate the scheme.

Prosecutors also charged Charles Bowie, 53, alleging he billed Medicaid while traveling internationally, including trips to Saudi Arabia, Jamaica and Colombia. Authorities said the scheme involved about $600,000 in Medicaid billings, most of which were fraudulent.

Another indictment accuses Benevolent Home Health LLC and its owners, Khaleelah Williams, 49, and Saleemah Davis, 29, of health care fraud conspiracy and wire fraud. The company’s owners allegedly obtained about $224,000 in Medicaid payments through the scheme.

Prosecutors accused the Philadelphia-based home health care company of billing Medicaid for services allegedly performed by Williams’ husband while he was selling drugs and after he was arrested on drug trafficking charges. Davis and Williams also are accused of billing Medicaid for services allegedly provided by a home health aide who had died.

Reporting by Thao Nguyen, USA TODAY. USA TODAY Network via Reuters Connect.