The U.S. Department of Justice (DOJ) has expanded its Northeast Health Care Fraud Strike Force into Philadelphia, strengthening federal efforts to combat Medicaid and Medicare fraud. Alongside the expansion, federal and Pennsylvania authorities announced criminal charges against 19 defendants accused of participating in home care fraud schemes involving more than $4 million in false Medicare and Medicaid claims. Authorities also confirmed a plea agreement in a separate $1.7 million Medicaid fraud case.
Key highlights
| Item | Details |
|---|---|
| Strike Force expansion | Northeast Health Care Fraud Strike Force expands to Philadelphia |
| Defendants charged | 19 |
| Alleged fraudulent claims | More than $4 million |
| Separate plea agreement | Final defendant in previous 21-person case |
| Value of previous case | More than $1.7 million |
| Agencies involved | DOJ Fraud Division, U.S. Attorney’s Office (Eastern District of Pennsylvania), Pennsylvania Attorney General |
DOJ expands fraud enforcement in Pennsylvania
The Justice Department’s National Fraud Enforcement Division announced a significant expansion of its Northeast Health Care Fraud Strike Force into Philadelphia, Pennsylvania. The initiative brings together the DOJ’s Health Care Fraud Section and the U.S. Attorney’s Office for the Eastern District of Pennsylvania to strengthen investigations and prosecutions involving Medicare and Medicaid fraud.
The Health Care Fraud Strike Force has become one of the federal government’s most effective enforcement programs. Nationally, it has prosecuted more than 6,200 defendants accused of submitting over $45 billion in fraudulent claims to federal health care programs and private insurers.
Justice department withdraws business review letter issued to proxy advisory firm — DOJ
Nineteen defendants charged in alleged Medicaid fraud schemes
Allegations involve home care companies
Federal prosecutors announced criminal charges against 19 defendants, including owners and employees of home care companies, for allegedly participating in multiple fraud schemes involving more than $4 million in Medicare and Medicaid claims.
According to prosecutors, the schemes involved billing government health programs for home care services that were either not provided or were fraudulently documented.
Separate plea agreement announced
Authorities also announced that the final defendant in an earlier 21-defendant Medicaid fraud case has entered a plea agreement. That investigation involved more than $1.7 million in fraudulent claims submitted to government health care programs.
Officials said the latest enforcement actions demonstrate continued efforts to hold both individuals and corporate entities accountable for health care fraud.
Philadelphia becomes new enforcement hub
The DOJ said expanding the Strike Force into the Eastern District of Pennsylvania provides additional federal resources to a region with a long history of health care fraud enforcement.
Philadelphia is home to major health care providers, insurers, and health technology companies. Officials said the district has also played an important role in exposing corporate misconduct through civil litigation, helping law enforcement identify criminal conduct in the health care sector.
Medicare advantage provider complete health to pay $14,100,000 to settle false claims act suit — DOJ
Corporate enforcement remains a priority
The Fraud Division said it has significantly expanded its focus on corporate accountability. Recent corporate resolutions have involved companies including AP of South Florida LLC, Atlantic Biologicals Corp., ExThera, and Troy Health Inc.
The department also recently announced its first health care company declination under the DOJ’s new Corporate Enforcement Policy following a voluntary self-disclosure by Campus Eye, highlighting incentives for companies that voluntarily report misconduct.
Officials warn against Medicaid fraud
Assistant Attorney General Colin M. McDonald said Medicaid funding exists to support elderly and vulnerable Americans, not fraudulent schemes in which caregivers falsely claim to provide services while they are incarcerated or traveling.
He said the new charges and the Strike Force expansion send a clear message that the Justice Department will aggressively investigate and prosecute those who exploit public health care programs.
CMS Administrator Dr. Mehmet Oz said Medicaid fraud diverts taxpayer money away from patients who genuinely need care. He added that CMS is working with law enforcement while introducing new safeguards designed to identify suspicious claims before payments are made.
U.S. Attorney David Metcalf said investigators uncovered cases in which caregivers allegedly billed Medicaid while they were dead, incarcerated, or involved in criminal activity, describing home care fraud as a widespread problem that harms taxpayers.
Two houston gang leaders convicted at trial for ordering drive-by murder of innocent bystander — DOJ
FBI Philadelphia Special Agent in Charge Wayne A. Jacobs said health care fraud is not a victimless crime because it diverts critical resources from patients and undermines public trust. He emphasized that the FBI and its partners will continue pursuing complex fraud schemes involving government health care programs.
Investigation continues
The DOJ said the cases involve company owners, home health aides, Medicaid recipients, and individuals with significant criminal histories, reflecting the broad scope of its enforcement efforts.
Officials stated that the expanded Northeast Health Care Fraud Strike Force will use every available investigative and legal tool to identify, investigate, and prosecute individuals and organizations that misuse taxpayer-funded health care programs.
The Fraud Division, the U.S. Attorney’s Office for the Eastern District of Pennsylvania, and the Pennsylvania Attorney General’s Office said they will continue pursuing both corporate and individual offenders who seek to profit through Medicaid and Medicare fraud.