Four Pittsburgh Residents Charged with Conspiracy to Commit Health Care Fraud

[nitpicker]

https://www.justice.gov/usao-wdpa/pr/four-pittsburgh-residents-charged-conspiracy-commit-health-care-fraud

Department of Justice
U.S. Attorney’s Office
Western District of Pennsylvania

FOR IMMEDIATE RELEASE
Monday, October 22, 2018

Four Pittsburgh Residents Charged with Conspiracy to Commit Health Care Fraud

PITTSBURGH, Pa. – Four residents of Pittsburgh, Pennsylvania, were charged in federal court with conspiracy to defraud the Pennsylvania Medicaid program, United States Attorney Scott W. Brady announced today. Travis Moriarty, 37, Tiffhany Covington, 41, Autumn Brown, 31, and Brenda Lowry Horton, 48, all of Pittsburgh, Pennsylvania, were charged in separate but related criminal Informations with one count of conspiracy to commit health care fraud.

According to the Informations filed in their respective cases, the defendants 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&quot , including personal assistance services (PAS), service coordination, and non-medical transportation, among other services. In general, as alleged, PAS care involved the provision of non-medical assistance by company employees ("attendants&quot to consumers in their homes, including, for example, meal preparation, bathing, dressing, and light cleaning. Service coordination entailed coordinating and monitoring services on an ongoing basis, including PAS care, to ensure that consumers were receiving their authorized care pursuant to the relevant Medicaid program. Likewise, non-medical transportation benefits covered personnel and mileage costs for drivers to transport consumers, as well as the purchase of transit passes, tickets, or tokens to secure other means of transportation. As alleged, EPS provided back-office and staffing support for MCI, ADL, and CCI. Notwithstanding the formal corporate separation of these entities, the Informations allege that the finances of each were commingled at the direction of the owners of the entities.

According to the Informations, between in and around January 2011 and in and around April 2017, MCI, ADL, and CCI, collectively, received more than $87,000,000 in Medicaid payments based on claims submitted for these services, with PAS payments accounting for more than $80,000,000 of the total amount. During that time, the Informations allege that Moriarty, Covington, Horton, and Brown, along with numerous other individuals, 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 related to PAS, service coordination, and non-medical transportation services that were never provided to the consumers identified on the claims.

Among other things, the Informations allege that various office employees of MCI, ADL, and EPS, including Moriarty, Covington, and Horton, would fabricate timesheets to reflect the provision of in-home PAS care they provided to consumers but that, in fact, never occurred. In addition, at the direction of the owner of MCI, certain in-house employees of MCI, ADL, and EPS, including Moriarty, Covington, and Horton, stopped using their own names as the attendant on timesheets and instead used the names of "ghost employees." As alleged, some of the "ghost employees," including Brown, allowed their names to be used in this manner in exchange for a portion of the resulting salary payments derived from Medicaid disbursements. Other "ghost employees" never received kickbacks and otherwise had no knowledge of the fact of their fraudulent employment.

According to the Informations, other attendants employed by MCI 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, Medicaid claims were submitted for PAS care that purportedly occurred while consumers were hospitalized, incarcerated, or deceased. The Informations further allege that co-conspirators, including Moriarty, Covington, Brown, and Horton, paid kickbacks to consumers in exchange for the consumers’ agreement to participate in the submission of fraudulent timesheets in support of Medicaid claims.

The Informations further allege that the owner of MCI directed employees, including Moriarty and Covington, to use 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. Indeed, the Informations allege that many consumers had no knowledge that their personally identifiable information was being used to bill Medicaid for benefits that the consumers had not exhausted.

According to the Informations, as part of the conspiracy, the owner of MCI and others, directed employees, including Moriarty and Covington, to fabricate documentation during the course of state audits of MCI, ADL, and CCI—for example, PAS timesheets, service coordination notes, criminal history checks for attendants, child-abuse clearance forms for attendants, and certain consumer affidavits—as a means to conceal the nature and scope of the fraud and so that it could continue.
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