Pittsburgh Resident Pleads Guilty to Conspiracy and Health Care Fraud
PITTSBURGH, Pa. – A resident of Pittsburgh, Pennsylvania, pleaded guilty in federal court to one count each of conspiracy to defraud the Pennsylvania Medicaid program and health care fraud, United States Attorney Scott W. Brady announced today.
Julie Wilson, 48, pleaded guilty before United States District Judge Cathy Bissoon.
During her plea hearing, Wilson admitted that, at various times between 2011 and 2017, she was an employee of Moriarty Consultants, Inc. (MCI) and Everyday People Staffing, Inc. (EPS), two related entities operating in the home health care industry. The other entities were Activity Daily Living Services, Inc. (ADL) and Coordination Care, Inc. (CCI). 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. Wilson admitted that she was responsible for claims processing and billing matters related to Pennsylvania Medicaid. 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, Wilson 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. Among others, Wilson admitted that she conspired with Arlinda Moriarty, the owner of MCI, ADL, and EPS; Daynelle Dickens, the owner of CCI and Arlinda Moriarty’s sister; various office workers at the companies, including Tamika Adams, Tony Brown, Terra Dean, Larita Walls, Keith Scoggins, and Tia Collins; and attendants at MCI, including Tionne Street and Luis Columbie-Abrew.
As part of the conspiracy, Wilson admitted that she and various co-conspirators fabricated timesheets to reflect the provision of in-home PAS care they provided to consumers, when, in fact, no such care ever occurred. Wilson further admitted that, at Arlinda Moriarty’s direction, she collected information about consumers who had "unused" PAS care hours—that is, hours of authorized PAS care that had not been performed and, as a result, had not been billed to Pennsylvania Medicaid. In response, Wilson would provide lists of such consumers and their "unused" hours to Arlinda Moriarty and Daynelle Dickens. Moriarty, in turn, would direct Wilson to submit false claims, in bulk, for some or all of the "unused" hours—without the relevant consumers’ knowledge or consent. Wilson further admitted that she would then send Moriarty a list of the "unused" hours Wilson had billed and that required the creation of back-dated timesheets to document the purported care. Wilson further admitted that she caused Medicaid billings for purported in-home care of a consumer while the consumer was in the hospital, and that she obtained signature stamps for certain consumers that were used execute falsified timesheets in the consumers’ names.
The conspiracy and health care fraud charges each carry a maximum total sentence of not more than 10 years in prison, a fine of $250,000, or both. Under the Federal Sentencing Guidelines, the actual sentence imposed would be based upon the seriousness of the offense and the prior criminal history, if any, of the defendant.
To date, a total of 16 defendants have been charged in connection with this investigation. Wilson is the sixth defendant to enter a guilty plea. The remaining defendants are presumed innocent unless and until proven guilty.
Assistant United States Attorneys Eric G. Olshan and Special Assistant United States Attorney Edward Song are prosecuting this case on behalf of the government. The Federal Bureau of Investigation, Pennsylvania Office of the Attorney General – Medicaid Fraud Control Unit, Internal Revenue Service – Criminal Investigation, U.S. Department of Health and Human Services – Office of Inspector General, and United States Postal Inspection Service conducted the investigation of the defendants.