Pittsburgh Resident Pleads Guilty to Conspiracy, Health Care Fraud and Aggravated Identity Theft
PITTSBURGH, Pa. – A resident of Pittsburgh, Pennsylvania, pleaded guilty in federal court to one count each of conspiracy to defraud the Pennsylvania Medicaid program, health care fraud, and aggravated identity theft, United States Attorney Scott W. Brady announced today.
Tamika Adams, 43, pleaded guilty before United States District Judge Cathy Bissoon.
During her plea hearing, Adams admitted that at various times between 2011 and 2017 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 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 home health services, with PAS payments accounting for more than $80,000,000 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 an attendant, while also working full-time as the nominal president of ADL. Adams further admitted that she caused the submission of Medicaid claims in the name of "ghost" employees for PAS care that never occurred. 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 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.
Judge Bissoon scheduled Adams’s sentencing for 2:15 p.m. on July 8, 2020.
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. The aggravated identity theft charges carry a mandatory sentence of two years in prison to run consecutively with any sentence imposed on any other charge and a fine of no more than $250,000. 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 sixteen defendants have been charged in connection with this investigation. Adams is the twelfth 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.