Pittsburgh resident sentenced to more than five years in prison for conspiracy, health care fraud, and aggravated identity theft

 

Date: December 1, 2021

Contact: newsroom@ci.irs.gov

Pittsburgh, PA — A resident of Pittsburgh, Pennsylvania, was sentenced in federal court for conspiracy to defraud the Pennsylvania Medicaid program, health care fraud, and aggravated identity theft, United States Attorney Cindy K. Chung announced today.

United States District Judge Cathy Bissoon sentenced Tamika Adams to sixty-five months of imprisonment, followed by two years of supervised release, for her role in a years-long conspiracy. Adams was also ordered to pay restitution to the Pennsylvania Medicaid program in the amount of $445,131.67.

During her plea hearing on March 13, 2020, Adams admitted that at various times between 2011 and 2014 she was an employee of three 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). MCI, ADL, and a fourth entity, Coordination Care, Inc. (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. EPS nominally performed back-office functions for MCI, ADL, and CCI.

Between January 2011 and the defendant's departure from the entities in and around 2014, MCI, ADL, and CCI collectively received tens of millions of dollars in Medicaid payments based on claims submitted for home health services, with PAS payments accounting for the vast majority of the total amount. During that time, Adams 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, Adams admitted that she fabricated timesheets to reflect the provision of in-home PAS care that, in fact, she never provided to the consumer identified on the timesheets. In one instance, Adams admitted submitting false timesheets claiming that she provided more than 80 hours of care in a single week to a consumer, while also working full-time as the nominal president of ADL. During a two-year period in which the same consumer lived with Adams, the defendant admitted taking steps to conceal their co-habitation and the fact that she served as the consumer's power of attorney (both disqualifying circumstances) from the Medicaid program.

Likewise, Adams admitted that she paid kickbacks to at least one consumer—her spouse at the time—in exchange for his participation in the scheme. Specifically, Adams admitted that she and her father, co-defendant Tony Brown, used Brown's name on time sheets for fabricated care of Adams's then-spouse. At various times, Adams admitted that she, Tony Brown, and her spouse would meet at an MCI office on the day that Brown received payment for the fraudulent care so that the three individuals could divide the proceeds. In total, Adams acknowledged causing losses to the Pennsylvania Medicaid program in excess of $250,000 related to her spouse.

Adams also admitted that during the conspiracy, she caused the submission of Medicaid claims for PAS care that her friend, an MCI employee, purportedly provided to various consumers, without the friend's knowledge and when in fact no such care had been provided to the consumers. During this time, Adams admitted that her friend was recovering from a serious injury and unable to work. Adams further misused her friend's personally identifiable information to obtain and misappropriate the resulting salary payments. Finally, Adams admitted that during the course of audits of MCI, ADL, and CCI, she fabricated documentation for submission to state authorities in an effort to conceal the Medicaid fraud scheme. Among other things, Adams fabricated PAS timesheets, criminal history checks for attendants, child-abuse clearance forms for attendants, and certain consumer affidavits to ensure that files requested as part of the audits appeared complete.

To date, a total of sixteen defendants have been charged in connection with this investigation. Adams was the twelfth defendant to enter a guilty plea. The remaining defendants, including Tony Brown, are presumed innocent unless and until proven guilty.

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