Office of Attorney General’s Medicaid Fraud Control Unit Nominated for Inspector General’s Award for Excellence in Fighting Fraud, Waste, and Abuse

March 13, 2019 | Topic: OAG News

HARRISBURG — Attorney General Josh Shapiro today announced the Office of Attorney General’s Medicaid Fraud Control Unit (MFCU) was nominated for the Inspector General’s Award for Excellence in Fighting Fraud, Waste, and Abuse for the 2019 Honor Awards Ceremony.

During the 2018 fiscal year, the Pennsylvania MFCU obtained significant case outcomes, including 164 arrests, 105 convictions, and total recoveries of over $22 million. Over the prior two fiscal years, the Unit obtained a total of 190 arrests, 171 convictions, and recoveries of nearly $56 million.

Accounting for the number of staff, the Pennsylvania Unit’s FY 2018 case outcomes ranked third out of all MFCUs. The Unit currently employs 68 attorneys, investigators, auditors, nurse analyst and other professionals, under the direction of Chief Deputy Attorney General Laurie Malone since 2017.

“Our robust Medicaid Fraud Control Unit works hard every day to root out fraud, neglect, and abuse in the Commonwealth. We are proud of the work they have accomplished in a short amount of time and honored by the nomination of the Inspector General’s award,” Attorney General Josh Shapiro. “Under the leadership of Chief Deputy Attorney General Laurie Malone, the Unit remains committed to ensuring the safety of Pennsylvanians.”

In 2018, the Pennsylvania MFCU participated in 63 joint investigations with Office of Inspector General (OIG), Office of Investigations (OI), a high number of joint cases for a Unit the size of Pennsylvania’s. The  strong collaboration with OIG has permitted OIG to “embed” an OI agent  within the MFCU.  The Unit participated in the 2018 National Health Care Fraud Takedown and charged 15 individuals involving nearly $237,000 in fraudulent payments. The charges involved a range of providers—personal care attendants, behavioral health providers, and Medicaid case managers.

In August 2018, in response to modifications proposed by the MFCU, Pennsylvania’s patient neglect statute was amended, expanding the Unit’s authority to investigate abuse and endangerment of care-dependent persons. In November 2018, OIG approved the Unit’s application to conduct data mining, becoming the sixteenth MFCU with that authority.

The Pennsylvania MFCU is active in the National Association of Medicaid Fraud Control Units (NAMFCU). The MFCU director serves on the Executive Committee, a Senior Attorney serves as a Training Coordinator, various members of the MFCU team sit on Global Case Committees and several members of the MFCU staff serve as instructors for national trainings.  .

Just this past week, the MFCU secured a sentence of 50 – 100 months in a state correctional institution for a York County man who falsified his educational credentials and did not disclose  his full criminal history before he took a job working with children with disabilities.

In another case, the MFCU, OI and the Internal Revenue Service launched an investigation into the owner and operator of a home health agency who allegedly created false identification documents and fictitious occupational licenses for workers to submit claims to Medicaid for services not provided or services provided by someone not qualified to provide the services. The CEO was sentenced to 36 months in prison and ordered to pay over $1 million in restitution for making false statements relating to health care matters, engaging in monetary transactions involving criminally-derived property, and identity theft.

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