Three sentenced in $87 million Medicaid fraud scheme

Three people who were part of a sophisticated, $87 million health care fraud scheme were sentenced Wednesday in federal court in Pittsburgh.

The three were among a total of 16 people charged for billing Pennsylvania Medicaid for in-home health care for services that were never performed. Fifteen of those people have now been convicted, the government said. The other person died while the case was pending.

On Wednesday, U.S. District Judge Cathy Bissoon sentenced Arlinda Moriarty, 53, of Cranberry to seven years in prison.

Her sister, Daynelle Dickens, 48, of Pittsburgh was ordered to serve two years, and their uncle, Tony Brown, 65, was ordered to serve three years probation, including three months on house arrest.

The three, who pleaded guilty in May, must also pay restitution. For Moriarty, that amount is $8.7 million.

According to the U.S. Attorney’s Office, the three defendants were associated with three entities controlled by Moriarty — Moriarty Consultants Inc., Activity Daily Living Services Inc., and Coordination Care Inc.

Between January 2011 and April 2017, prosecutors said, the entities received more than $87 million in Medicaid payments based on claims submitted for home health care, including personal assistance services.

However, the government said, the claims were fraudulent and the care was never provided to the patients identified in the claims.

“Patients” received kickbacks

Among the schemes the defendants used, the U.S. Attorney’s Office said — they would fabricate time sheets to reflect at-home care; and they paid kickbacks to the patients identified in exchange for their participation in the scheme.

Moriarty also admitted that she directed the fabrication of various documents for submission to the state to conceal the Medicaid fraud.

Including in those fabrications, the government said, were time sheets, criminal history checks for attendants, child abuse clearance forms and affidavits.

Prosecutors said that Moriarty received payments of $1.6 million, while Dickens received $1 million.

“She undermined the integrity of federal health care programs and patient trust. Now, she faces the consequences of her actions,” said FBI Pittsburgh Special Agent in Charge Mike Nordwall. “Today’s sentencing is a strong reminder that anyone who commits fraud will be held accountable. The FBI will continue to work with our law enforcement partners to expose fraud and protect the public from illegal schemes.”