AG Sunday’s Medicaid Fraud Control Section ranked No. 3 in criminal convictions nationwide; a few recent cases are highlighted
HARRISBURG – Attorney General Dave Sunday announced the release of an annual report that ranks his office’s Medicaid Fraud Control Section at No. 1, nationally, in number of fraud charges filed against individuals, and third overall in convictions secured, taking action against those who steal from Pennsylvania’s Medicaid program which provides limited-income and vulnerable populations with access to healthcare.
Pennsylvania’s Medicaid Fraud Control Section, housed in the Office of Attorney General, prosecutes those who defraud the program through unlawful billing or failure to provide services. The Medicaid Fraud Control Section also prosecutes those who neglect or abuse Pennsylvanians most dependent on their care, and those who financially exploit older adults or care-dependent persons.
During the 2024 federal fiscal year, the section recovered more than $11.3 million in misused Medicaid funding, most through criminal prosecutions. During that same year, the section filed fraud charges against 113 people, filed neglect, abuse, and endangerment charges against 6 people, and secured convictions in 74 cases, which were filed last year or in previous years.
“Those who defraud our Medicaid program take vital services away from those in need while violating taxpayers who help fund the program,” Attorney General Sunday said. “I am proud of our unit’s ranking among peers, and assure Pennsylvanians that our commitment to expose waste, fraud and abuse, and to prosecute offenders will not stop. These are not victimless crimes, as people in need of medicine and personal care are harmed the most by fraudsters.”
The report, released by the U.S. Department of Health and Human Services Office of Inspector General, highlights that Medicaid Fraud units across the country recover $3.46 for every $1 spent by the units.
Some recent highlights from the past week of the Pennsylvania Office of Attorney General’s work to combat Medicaid Fraud in southeastern Pennsylvania:
- Dana Mason, 63, of Philadelphia County, was charged this past Tuesday with accusations of Medicaid Fraud, Theft by Deception, and Tampering with Public Records, regarding claims she made for personal care services for a person who was deceased. Mason allegedly received more than $33,000 in payments from Medicaid-funded managed care organization, AmeriHealth, for services that were alleged to have never been provided.
- Lewis Warner, 24, of Delaware County, pleaded no contest Monday to Medicaid Fraud, and was sentenced to 6 to 23 months in prison and two years of consecutive probation. Warner submitted more than 400 fraudulent hours for personal care he was alleging to provide to a patient who was actually hospitalized. Warner was ordered to pay $9,232 in restitution.
- Shavon Parker, 39, a Licensed Practical Nurse from Philadelphia County, pleaded guilty Wednesday to Medicaid Fraud and Theft by Deception, for reporting nearly 2,000 hours of nursing services that she could not have provided, because investigators determined she was billing for caring for two different people at the same time or was traveling outside of the state or country at the time. Parker also owned a personal care agency through which she billed for fraudulent personal care services that her employees, including her sister, could not have provided because they too were traveling outside of the state or country, often with Parker. She will serve probation and was ordered to pay more than $96,000 in restitution.
- Polly Young, 60, of Delaware County, pleaded guilty on Thursday to Medicaid Fraud and was sentenced to 30 months of probation, and ordered to pay $10,271 in restitution. Young claimed she provided more than 500 hours of personal care services — during times she was working at a Burger King.
- Tyesha Willis, 48, of Philadelphia County, pleaded guilty on Wednesday to Medicaid Fraud for reporting hours of care when she was actually working as a school bus driver. She was sentenced to 24 months of probation and ordered to pay $5,636 in restitution.
Criminal charges, and any discussion thereof, are merely allegations and all defendants are presumed innocent until and unless proven guilty.
The Pennsylvania Medicaid Fraud Control Unit receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $12,839,940 for Federal fiscal year (FY) 2025. The remaining 25 percent, totaling $4,279,979 for FY 2025, is funded by Pennsylvania.
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