Pennsylvania Medicaid home-care fraud bust draws Minnesota comparisons

Key Points:

• The DOJ’s expanded anti-fraud task force made a major bust in Pennsylvania targeting Medicaid home-care service fraud, charging 19 defendants for criminal activity that diverts funds from disabled individuals relying on Medicaid.
• Pennsylvania spends $8 billion annually on Medicaid home-care services, the focus of the busts, and state officials, including Gov. Josh Shapiro and Attorney General David Sunday, emphasize strong bipartisan cooperation in combating fraud.
• Cases include billing Medicaid for services while suspects were pulled over by police, attending court hearings, driving rideshare, or incarcerated, highlighting egregious fraudulent behavior.
• Pennsylvania leads the nation in Medicaid fraud convictions, with 119 cases charged in 2024 and over $11 million recovered, supported by ongoing monitoring systems like electronic visit verification.
• The anti-fraud task force, part of a nationwide crackdown initially organized in Brooklyn and Newark, continues to pursue fraudulent providers aggressively, with agencies like the DEA Philadelphia chief warning medical providers against greed-driven misconduct.