A resident of Pittsburgh, Pennsylvania, pleaded guilty in a Pennsylvania federal court to conspiring to swindle the Pennsylvania Medicaid program, stolen identity theft, and health care crime, announced Scott W. Brady, United States Attorney today.
Tamika Adams, age 43, pled guilty before Cathy Bissoon, United States District Judge.
During her plea hearing, Adams confessed that on various occasions between 2011 and 2017 she was an employee of Activity Daily Living Services, Inc. (ADL), Everyday People Staffing, Inc. (EPS), and Moriarty Consultants, Inc. (MCI), three related companies dealing in home health care, and Coordination Care, Inc. (CCI), a fourth organization, certified under the Pennsylvania Medicaid program to provide Medicaid recipients (“consumers”) who qualified certain services, including personal assistance services (PAS), non-medical transportation, and service coordination, among other services. EPS negligibly carried out back-office operations for CCI, ADL, and MCI.
Between January 2011 and around April 2017, Coordination Care, Inc., Moriarty Consultants, Inc., and Activity Daily Living Services, Inc., in total, collected over $87,000,000 in Medicaid remittance based on declarations presented for home care services, with PAS payments making up for over $80,000,000 of the gross remittance. During that period, Adams confessed that she took part in a wide-array conspiracy to swindle the Pennsylvania Medicaid program for the purpose of collecting millions of dollars in fraudulent Medicaid payments through the presentation of fake claims for services that were never offered to the consumers listed on the claims, or for which there was inadequate or modified documentation to support the claims.
As part of the scheme, Adams confessed that she altered timesheets to indicate the provision of in-home PAS service that, in fact, she never offered to the patient listed on the timesheets. In one circumstance, Adams confessed presenting fake timesheets indicating that she offered more than 80 hours of care in a single week to a patient, while also ceaselessly working as the nominal president of ADL. Adams further confessed that she led the presentation of Medicaid claims in the name ghost workers for PAS care that were not offered. Likewise, Adams confessed that she paid kickbacks to at least one patient—her partner at the time—in return for his involvement in the scheme. Specifically, Adams confessed that she and her father, co-accused Tony Brown, used Brown’s name on timesheets for faked care of Adams’s spouse. On several occasions, Adams confessed that she, Tony Brown, and her partner would link up at an MCI office on the day that Brown collected payment for the fake care so that the three co-conspirators could share the proceeds. In total, Adams admitted causing the Pennsylvania Medicaid program losses in excess of $250,000 in connection to her partner.
Adams also confessed that during the scheme, she led the tabling of Medicaid claims for PAS care that her associate, an employee with MCI, supposedly offered to various patients, without the friend’s realization and when in fact no such care had been offered to the consumers. During this time, Adams confessed that her friend was recuperating from a serious injury and was unable to offer services. Adams further misemployed her friend’s personally identifiable information to acquire and embezzle the resulting salary payments. Finally, Adams confessed that during the audits of MCI, ADL, and CCI, she faked documentation for tabling to state authorities in an effort to hide her conniving fraud scheme. Among the things she faked, Adams faked PAS timesheets, child-abuse clearance forms for attendants, criminal records checks for attendants, and certain consumer testimonies to guarantee that files requested as part of the audits looked complete.
Judge Bissoon set Adams’s sentencing for 8th July 2020 at 2:15 p.m.
The scheme and health care fraud charges each weigh a maximum total punishment of not more than 10 years in federal prison, a $250,000 fine, or both. The stolen identity crime charges weigh a compulsory sentence of two years in federal prison to run consecutively with any sentence issued on any other charge, and a $250,000 fine. Under the Federal Sentencing Guidelines, the actual sentence issued would be hinged upon the seriousness of the crime and the past criminal record, if any, of the accused.
To date, 16 defendants have been prosecuted in connection with this inquiry. Adams is the twelfth defendant to petition a guilty plea. The remaining accused persons are presumed innocent unless and until proven guilty beyond a reasonable doubt.
Prosecuting the case on behalf of the government is Eric G. Olshan, Assistant United States Attorney and Special Assistant United States Attorney Edward Song. The Federal Bureau of Investigation, Internal Revenue Service – Criminal Investigation, Pennsylvania Office of the Attorney General – Medicaid Fraud Control Unit, U.S. Department of Health and Human Services – Office of Inspector General, and the United States Postal Inspection Service carried out the inquiry of the accused.
Do you know of any medical or health practitioner that is involved in fraudulent activities outside their professional oath? Have you been a victim of such health professionals? Do you know of any friend or family member that has gone through the hands of such rogue professionals for reasons that they were vulnerable? If you have answered yes to any of the questions, our legal team would like to hear from you. Individuals with relevant information in regards to the above cases are requested to contact us at 888-402-4054. Your call will go a long way in helping our team put a stop to Medicare fraud.