2 Pittsburgh women sentenced for their role in Medicaid fraud conspiracy

Two Pittsburgh women were sentenced in federal court for conspiracy to defraud the state Medicaid program.

U.S. District Judge Cathy Bissoon sentenced Autumn Brown, 31, and Brenda Lowry Horton, 48, to five years of probation, including six months of home detention, for their roles in a years-long conspiracy. Brown and Lowry Horton were also ordered to pay restitution of about $69,000 and $67,000, respectively, to the program.

During their respective plea hearings last December authorities said the defendants acknowledged working for Moriarty Consultants, Inc., Activity Daily Living Services and Everyday People Staffing, all part of the home health care industry.

Each of these entities was owned or controlled by Arlinda Moriarty. MCI and ADL were approved under the state Medicaid program to offer certain services to qualifying Medicaid recipients including personal assistance services, service coordination, and non-medical transportation, among other services. Between January 2011 and April 2017, MCI, ADL, and Coordination Care, collectively, received more than $87 million in Medicaid payments based on claims submitted for these services, with payments for personal assistance services accounting for more than $80 million of the total.

The defendants admitted that they participated in a wide-ranging conspiracy to obtain illegal payments from the Medicaid program by submitting claims for services that were never provided or there was insufficient or faked documentation to support the claims.

Authorities noted co-conspirators, including Horton, stopped using their own names as the attendant on time sheets. They instead used the names of “ghost” attendants, some of whom allowed their names to be used in exchange for a kickback for fraudulent salary payments.

Horton also admitted she and others paid kickbacks to customers in exchange for the customer’s agreeing to sign, or allow their names to be forged on, false time sheets.

So far, 16 people have been charged with offenses related to the conspiracy.

The FBI, state Attorney General’s Office Medicaid Fraud Control Unit, the IRS, U.S. Department of Health and Human Services’ Office of Inspector General, and U.S. Postal Inspection Service conducted the investigation.