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Sat Apr 13, 2019, 05:13 AM

Two Defendants Sentenced in Multi-Million Dollar Health Care Fraud Conspiracy

PITTSBURGH, Pa. – Two residents of Pittsburgh, Pennsylvania, were sentenced in federal court for conspiracy to defraud the Pennsylvania Medicaid program, United States Attorney Scott W. Brady announced today.

United States 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 to the Pennsylvania Medicaid program in the amount of $68,917.80 and $67,107.32, respectively.

During their respective plea hearings in December 2018, the defendants admitted that they were employees of one or more related entities operating in the home health care industry—Moriarty Consultants, Inc. (MCI), Activity Daily Living Services, Inc. (ADL), and Everyday People Staffing, Inc. (EPS). Each of these entities was owned or controlled by Arlinda Moriarty. MCI and ADL 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 in and around January 2011 and in and around April 2017, MCI, ADL, and another related entity (Coordination Care, Inc.), 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 defendants admitted that they participated in a wide-ranging conspiracy to defraud the Pennsylvania Medicaid program for the purpose of obtaining 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, various office workers at the companies, including Tiffhany Covington and Tia Collins. As part of the conspiracy, the defendants admitted that they fabricated timesheets to reflect the provision of in-home PAS care they provided to consumers but that, in fact, never occurred. In addition, at Arlinda Moriarty’s direction, certain co-conspirators, including Lowry Horton, 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. Brown admitted that she allowed her name to be used in this manner and that she received a portion of the fraudulent proceeds from Ms. Covington. Lowry Horton further admitted that, as part of the conspiracy, she and others paid kickbacks to consumers in exchange for the consumers’ agreement to sign—or allow their names to be forged on—false timesheets.

Read more: https://www.justice.gov/usao-wdpa/pr/two-defendants-sentenced-multi-million-dollar-health-care-fraud-conspiracy

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Reply Two Defendants Sentenced in Multi-Million Dollar Health Care Fraud Conspiracy (Original post)
TexasTowelie Apr 2019 OP
Scarsdale Apr 2019 #1
Evolve Dammit Apr 2019 #2
Honeycombe8 Apr 2019 #4
TheFarseer Apr 2019 #3

Response to TexasTowelie (Original post)

Sat Apr 13, 2019, 07:14 AM

1. Imagine how much is lost

to fraud nationwide? No wonder the gop is determined to shoot down "Medicare for All". It would likely be more cost efficient than the various programs in place now. Not to mention the loss of income for the politicians who vote to keep these programs in effect. Chances are, implementing a National Health Service would actually SAVE money for the entire country. Sure it would be a hassle at first, but well worth the effort.

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Response to TexasTowelie (Original post)

Sat Apr 13, 2019, 08:03 AM

2. Again, no jail time for "white collar" crime. Don't steal a candy bar though....

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Response to Evolve Dammit (Reply #2)

Sat Apr 13, 2019, 08:12 AM

4. Outrageous. No jail time for stealing tens of thousands of dollars?

Restitution? Like there's a chance in hell of them paying that kind of money back?

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Response to TexasTowelie (Original post)

Sat Apr 13, 2019, 08:07 AM

3. Probation?

Are you kidding me? Am I just the only person that is pissed off by fraud? I think fraud, identity theft etc should be penalized much more harshly.

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