3 Pittsburgh residents pleaded guilty in fraud scheme to gain millions from Pa.'s Medicaid program
Three Pittsburgh residents pleaded guilty in federal court to conspiracy charges for their role in a scheme to defraud the Pennsylvania Medicaid program of millions in illegal payments.
Travis Moriarty, 37, Tiffhany Covington, 41, and Brenda Lowry Horton, 48, pleaded guilty to one count of conspiracy in separate hearings before U.S. District Judge Cathy Bissoon.
Federal authorities said 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., Activity Daily Living Services, Inc., Coordination Care, Inc., and Everyday People Staffing.
MCI, ADL, and CCI were approved under the Pennsylvania Medicaid program to offer services to qualifying Medicaid recipients, including personal assistance services, service coordination, and non-medical transportation, among others.
The three companies collectively received more than $87 million in Medicaid payments based on claims submitted for these services between January 2011 and April 2017. Personal assistance services payments accounted for more than $80 million of the total.
Authorities said during that time the defendants admitted they illegally collected millions by submitting fraudulent claims for services that were never provided.
Federal authorities say the defendants conspired with, among others, Arlinda Moriarty, the owner of MCI, ADL, and EPS; Daynelle Dickens, owner of CCI and Arlinda Moriarty’s sister; various office workers at the companies, including Julie Wilson, Tamika Adams, Tony Brown, Terra Dean, Larita Walls, Keith Scoggins, and Tia Collins; attendants at MCI, including Tionne Street, Autumn Brown, and Luis Columbie-Abrew; and Terry Adams, a consumer.
A federal grand jury indicted all of those suspects Nov. 26 except for Autumn Brown. She was charged by the IRS on Oct. 18 and a plea hearing is scheduled for Dec. 14.
Authorities said Moriarty, Covington, and Horton admitted that co-conspirators fabricated time sheets to reflect in-home care that never occurred.
In addition, according to authorities, at Moriarty’s direction, certain co-conspirators stopped using their own names as the attendant on time sheets and instead used the names of “ghost” attendants, some of whom allowed their names to be used in exchange for a kickback.
Defendants Moriarty, Covington, and Horton also admitted that certain co-conspirators submitted false time sheets for personal assistance services they never provided during times when they were actually working at other jobs or living out of the area.
In some cases, Medicaid claims were submitted for care that purportedly occurred while the patient was hospitalized, incarcerated, or deceased.
In other instances, patients were paid to allow fraudulent time sheets to be submitted in support of Medicaid claims.
Authorities said the three admitted the Moriarty directed co-conspirators to bill the maximum allowable personal assistance services 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.
Authorities said many consumers had no knowledge that their information was being used to bill Medicaid for benefits that the consumers had not exhausted.
During the plea hearings, defendants Moriarty, Covington, and Horton said Moriarty directed employees to fabricate documentation during the course of state audits, authorities said.
The FBI, Pennsylvania Office of the Attorney General – Medicaid Fraud Control Unit, IRS - Criminal Investigations, U.S. Department of Health and Human Services – Office of Inspector General, and U.S. Postal Inspection Service conducted the investigation.
Michael DiVittorio is a Tribune-Review staff writer. You can contact Michael at 412-871-2367, firstname.lastname@example.org or via Twitter @MikeJdiVittorio.