HARRISBURG — Attorney General Dave Sunday announced that two Pennsylvania Office of Attorney General Medicaid Fraud cases are featured in the Department of Justice’s National Health Care Fraud Takedown initiative — a nationwide law enforcement effort, against 324 defendants regarding $14.6 billion in intended loss.
In one case, Michael E. Miller, a former counselor in Lycoming County, is facing charges for sexually extorting a patient, and billing for the sessions in which he engaged in sexual acts.
The second Pennsylvania case involves charges against Khalil Rashid Rivera, a blended case manager with a Children’s Services Center in Luzerne County, who billed Medical Assistance for services he never provided to dozens of children.
The national enforcement effort led to actions filed against 96 doctors, nurse practitioners, pharmacists and other medical professionals, resulting from federal and state law enforcement investigations.
“These cases are not instances of mistaken billing — they involve providers who were criminally unprofessional, and in some cases, predatory, towards people they were trusted to care for,” Attorney General Dave Sunday said. “The cases charged by my office involve egregious conduct: one provider crossed every professional and ethical boundary to engage in sex acts with a patient, while the other abandoned families who needed him for months at a time while asking them to sign off on paperwork with bogus hours. These bad actors cannot be allowed to harm their patients and steal from a healthcare system that is depended on by so many Pennsylvanians.”
– Miller, 36, is accused of having inappropriate contact with a patient during sessions from July 2023 until Feb. 2024, which he billed to Medical Assistance. The case was referred to the Office of Attorney General from the Pennsylvania Department of State.
Miller’s sessions frequently involved inappropriate touching, and inappropriate disclosures about his own personal life. He event went to the patient’s home for a “session” during which he smoked marijuana with the patient, showered with her and engaged in sexual acts.
The patient told investigators that she was afraid if she didn’t let Miller touch her, she wouldn’t get the therapy she needed and he might drop her as a client. Over the course of the fraudulent and abusive sessions, Miller submitted fraudulent claims totaling $7,086.60.
– Rivera, 30, was charged following a recommendation from the 51st Statewide Investigating Grand Jury. In January 2023, concerns were raised about Rivera not seeing patients, despite his billing records, after one family told the facility that they had not seen him for nearly a year.
During an internal review, the facility found that many of times Rivera had documented and billed as doing visits at clients homes and other places outside the office, his badge access card log showed that he was at the office.
Multiple families shared that they hadn’t seen him for extended periods of time, or that time between visits grew longer and longer. He also began bringing forms that indicated he had done a visit, but would bring multiple copies and have families sign them all at once.
In all, Rivera billed thousands of fraudulent claims for 54 different clients, resulting in the overpayment of more than $72,000 in Medicaid funds.
Monday’s takedown was led and coordinated by the Health Care Fraud Unit of the Department of Justice Criminal Division’s Fraud Section, and its partners from the U.S. Attorney’s Office, the Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation and the Drug Enforcement Administration.
The cases involved in the takedown are being prosecuted by the Health Care Fraud Strike Force teams from the Criminal Division’s Fraud Section, 50 U.S. Attorney’s Offices nationwide and 12 State Attorneys General Offices, including the Pennsylvania Office of Attorney General’s Medicaid Fraud Control Unit, which is handling the two above-described cases.
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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