Pittsburgh resident sentenced in multimillion dollar health care fraud conspiracy

 

Date: December 9, 2020

Contact: newsroom@ci.irs.gov

Pittsburgh, Pa. – A resident of Pittsburgh was sentenced in federal court for conspiracy to defraud the Pennsylvania Medicaid program and health care fraud.

United States District Judge Cathy Bissoon sentenced Terra Dean to four years of probation, including six months of home detention for her role in a years-long conspiracy. Dean was also ordered to pay restitution to the Pennsylvania Medicaid program in the amount of $94,101.55.

During her plea hearing on January 21, 2020, Dean admitted that between 2011 and 2017 she was an employee of Moriarty Consultants, Inc. (MCI), one of four related entities operating in the home health care industry. The other three entities were 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"), 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 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, Dean admitted that she 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 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. As part of the conspiracy, Dean admitted that she fabricated timesheets to reflect the provision of in-home PAS care that, in fact, she never provided to the consumers identified on the timesheets. Dean further admitted that she caused the submission of Medicaid claims in the name of "ghost" employees—including, close relatives—for PAS care that was never provided to the consumers specified on Medicaid claims. Likewise, Dean admitted that she paid kickbacks to consumers in exchange for the consumers' cooperation in the fraudulent billing scheme. In total, Dean admitted causing losses to the Pennsylvania Medicaid program in excess of $150,000.

To date, twelve defendants have pleaded guilty for their roles in the conspiracy.

The Internal Revenue Service – Criminal Investigation, Federal Bureau of Investigation, Pennsylvania Office of the Attorney General – Medicaid Fraud Control Unit, U.S. Department of Health and Human Services – Office of Inspector General, and United States Postal Inspection Service conducted the investigation of the defendants.

Assistant United States Attorney Eric G. Olshan and Special Assistant United States Attorney Edward Song are prosecuting this case on behalf of the government.