Three Remaining Defendants Sentenced for Their Roles in Extensive Health Care Fraud Conspiracy to Defraud Medicaid Home Care Program
A Total of Fifteen Defendants Have Been Convicted in Connection with the Conspiracy
PITTSBURGH, Pa. – Three residents of the Pittsburgh area were sentenced in federal court for conspiracy to defraud the Pennsylvania Medicaid program and related offenses, United States Attorney Cindy K. Chung announced today.
United States District Judge Cathy Bissoon sentenced Arlinda Moriarty, 53, of Cranberry, to 84 months’ imprisonment; her sister, Daynelle Dickens, of Pittsburgh, 48, to 24 months’ imprisonment; and their uncle, Tony Brown, 65, to 36 months of probation, including 3 months of home confinement. Moriarty, Dickens, and Brown were also ordered to pay restitution to the Pennsylvania Medicaid program totaling $8,700,000, $1,000,000, and $43,113.02, respectively. All three defendants previously pleaded guilty to conspiracy to commit health care fraud and health care fraud. Moriarty pleaded guilty to additional counts of engaging in a scheme to conceal material facts in a health care matter and aggravated identity theft.
A total of 16 defendants were charged in connection with the health care fraud conspiracy and scheme, and 15 have now been convicted. The remaining defendant died during the pendency of the case.
“During this elaborate, years-long scheme, Arlinda Moriarty, her sister, and 13 of their co-conspirators stole millions of dollars from a critical government health care program by billing for in-home services that were never rendered,” said U.S. Attorney Chung. “I commend our law enforcement partners for their extraordinary efforts to investigate this massive health care fraud scheme, as well as the prosecutors who held the perpetrators accountable.”
“Ms. Moriarty sought to profit by defrauding the Medicaid program,” said FBI Pittsburgh Special Agent in Charge Mike Nordwall. “She undermined the integrity of federal health care programs and patient trust. Now, she faces the consequences of her actions. Today’s sentencing is a strong reminder that anyone who commits fraud will be held accountable. The FBI will continue to work with our law enforcement partners to expose fraud and protect the public from illegal schemes.”
“When someone commits Medicaid fraud they are stealing from hard working Pennsylvanians,” said Attorney General Josh Shapiro. “These defendants made millions of dollars by defrauding Pennsylvanians and will now face the consequences for their actions. I am grateful for the work that my office, the Federal Bureau of Investigation, the Internal Revenue Service, the U.S. Department of Health and Human Services, and the United States Postal Inspection Service have done to bring justice in this case.”
“Defrauding federal and state health care programs wastes valuable taxpayer dollars and takes resources away from vulnerable populations in need of care and assistance,” said Maureen R. Dixon, Special Agent in Charge with the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG is proud to work with our law enforcement partners to hold accountable perpetrators of health care fraud.”
“Postal Inspectors value the partnerships with other federal and state agencies that helped identify and dismantle an intricate false billing scheme,” said Inspector In Charge Lesley Allison for the U.S. Postal Inspection Service. “Arlinda Moriarty and her co-conspirators took advantage of the Medicaid waiver program that was devised to allow qualified individuals to receive assistance in their own homes. Today’s sentencing confirms that anyone who uses the U.S. Mail for criminal activity will be brought to justice and held accountable.”
According to admissions made in connection with the defendants’ guilty pleas, between January 2011 and April 2017, Moriarty, Dickens, and Brown were associated with four related entities controlled by Moriarty—Moriarty Consultants, Inc. (MCI), Activity Daily Living Services, Inc. (ADL), Everyday People Staffing, Inc. (EPS), and Coordination Care, Inc. (CCI). Dickens owned CCI, and Brown was an employee of MCI. 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. EPS nominally performed back-office functions for MCI, ADL, and CCI.
Between January 2011 and 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, Moriarty admitted orchestrating a wide-ranging conspiracy to defraud Medicaid 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.
The defendants admitted that the conspiracy and fraud scheme were carried out in a variety of ways. For example, co-conspirators fabricated timesheets to reflect the provision of in-home PAS care that, in fact, they never provided to the consumers identified on timesheets. Members of the conspiracy also paid kickbacks to consumers in exchange for their participation in the scheme. Indeed, Brown admitted paying kickbacks to his then-son-in-law in connection with the submission of fraudulent Medicaid claims stating that Brown had provided in-home care for the son-in-law, when, in fact, he had not. Brown, the son-in-law, and Brown’s daughter, Tamika Adams, who previously was sentenced to 65 months’ incarceration, would then split the fraud proceeds. As part of the conspiracy, co-conspirators also caused the submission of Medicaid claims in the name of “ghost” employees for PAS care that never occurred.
During the conspiracy, Moriarty and Dickens also admitted causing the periodic bulk submission of fraudulent Medicaid claims for so-called “unused” hours—i.e., excess hours of care that consumers had not needed and therefore should not have been billed. Finally, Moriarty admitted that during the course of audits of MCI, ADL, and CCI, she directed the fabrication of various documents for submission to state authorities in an effort to conceal the Medicaid fraud scheme. Among other things, co-conspirators 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. During the conspiracy, Moriarty and Dickens received payments from the Moriarty-related companies totaling approximately $1.6 million and $1 million, respectively.
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 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, with assistance from the Pennsylvania Bureau of Financial Operations.