VERDICT: Jury Convicts Philadelphia Care Worker of Medicaid Fraud for Claiming Hundreds of Home-Care Hours When Patient was Hospitalized

March 8, 2024 | Topic: Criminal

HARRISBURG — Attorney General Michelle Henry announced a Philadelphia man was convicted at trial of Medicaid fraud and related crimes for causing the Medicaid program to pay more than $4,200 for hours he claimed to have provided home care — when, in reality, the patient was in hospitals.

A Montgomery County jury returned its verdict Thursday, following two days of testimony regarding Felipe L. Santos and the home care he fraudulently claimed to have provided for his mother-in-law between October 2020 and May 2021.

Santos, 30, was convicted of four counts of Medicaid fraud, four counts of tampering with public records, and theft by deception — all felonies. He will be sentenced on a date to be determined in May.

“Prosecuting these crimes is vital to maintaining the integrity of a healthcare system that helps Pennsylvanians receive care,” Attorney General Henry said. “This defendant intentionally defrauded the system and is now held accountable thanks to the tenacious work of our investigators and prosecutors.”

The Office of Attorney General investigation revealed that Santos had reported that he provided services during dates and times when his mother-in-law was hospitalized at Aria-Jefferson Hospital, Frankford Campus, and Temple University Hospital. Santos submitted those hours to Philadelphia-based home care agency, Help at Home, causing Help at Home to seek reimbursement from PA Health and Wellness, a Medicaid-funded managed care organization.

In total, Santos claimed at least 262.5 hours he could not have performed, for which Medicaid (through PA Health and Wellness) paid out at least $4,297.74.

Senior Deputy Attorney General Jason Karasik prosecuted the case.

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 $10,632,312 for Federal fiscal year (FY) 2024. The remaining 25 percent, totaling $3,544,100 for FY 2024, is funded by Pennsylvania.

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