PENNSYLVANIA OFFICE OF THE ATTORNEY GENERAL: Attorney General Shapiro Announces 15 Arrests in Statewide Medicaid Fraud Sweep

By Press release submission | Jul 7, 2018

Attorney General Josh Shapiro announced felony Medicaid fraud charges against 15 people in seven counties across Pennsylvania.

Pennsylvania Office of the Attorney General issued the following announcement on June 29.

Attorney General Josh Shapiro announced felony Medicaid fraud charges against 15 people in seven counties across Pennsylvania. The Office of Attorney General conducted the arrests as it participated in a nationwide health-care fraud initiative this week.

The charges, arising out of 12 investigations, identified more than $237,000 in fraudulent reimbursements paid by Pennsylvania’s Medicaid Program. The initiative was coordinated by the Inspector General for the U.S. Department of Health and Human Services and the U.S. Justice Department.

“These Medicaid fraud cases involve 15 defendants who stole tax dollars, falsified records for care they were supposed to provide, and lied for personal gain,” Attorney General Josh Shapiro said. “Medicaid provides essential medical care to low-income Pennsylvanians and children with serious medical conditions. Criminals who defraud Medicaid are stealing from our most vulnerable Pennsylvanians. I’m holding them accountable.”

Southeast Pennsylvania

Peter Jarbo, of Philadelphia, was charged in Montgomery County with Medicaid fraud, theft by deception, and tampering with public records for billing for overlapping services to different children at three different child therapy agencies at which he was employed. Medicaid paid $37,933 for these fraudulent hours.

Kenya Miller, of Philadelphia, was charged in Bucks County with Medicaid fraud, theft by deception, and tampering with public records for billing care for her father after her father had died. Miller was employed as a personal care attendant for her father. The investigation revealed that Miller billed 2,037 fraudulent hours, and Medicaid paid $39,606 for these falsely billed hours.

Darryl Payne, of Williamsport, was charged in Montgomery County with Medicaid fraud, theft by deception, forgery and tampering with public records for billing for $100,139 of services that were not rendered. In his role as a certified peer specialist, Payne was certified to support others in their recovery process based on their own personal experiences. Medicaid paid Payne for services he did not perform.

Sarah Sibel, of Blue Bell, was charged in Bucks County with Medicaid fraud, theft by deception, forgery and tampering with public records for billing for services she did not provide. Sibel was employed as a mobile therapist, providing behavioral health services to Medicaid recipients, including to adolescent clients. Sibel submitted encounter forms for dates when she was employed elsewhere and forged parent signatures to perpetrate the fraud. Medicaid paid $1,746 for services not provided.

Northeast Pennsylvania

Lenor Grier, of Long Pond, was charged in Luzerne County with Medicaid fraud, theft by deception, and tampering with public records for billing for services she did not provide. A case manager, Grier was required to meet face-to-face with mentally-handicapped clients to assist with linking them to community resources required for their daily living. Grier billed Medicaid $3,100 in fraudulent submissions.

Central Pennsylvania

Katherine Baldwin, of New Holland, was charged in Lancaster County with Medicaid fraud, theft by deception, and tampering with public records for inflating the number of hours of service she provided. A community-based case manager, Baldwin was supposed to meet with mentally handicapped clients. Medicaid paid Baldwin $6,300 for fraudulent claims.

Laura Dunn and Diane Espenshade, of Elizabethtown, were charged in Dauphin County with Medicaid fraud, theft by deception, tampering with public records, and conspiracy. Dunn and Espenshade submitted fraudulent claims to Medicaid that stated Dunn provided services during times when Espenshade was in the hospital, incarcerated in prison, and was receiving services from another agency. Medicaid paid $10,400 for the fraudulent claims.

Lori Ketcham, of Newburg was charged in Fulton County, with Medicaid fraud, theft by deception, tampering with public records, and forgery for billing for services not provided. Ketcham was employed as a certified peer specialist. Ketcham billed for overlapping services while she worked for two separate agencies. Medicaid paid $7,000 to Ketchum for the fraudulent billing.

Tyler R.J. Mausteller, of Willimsport, Pennsylvania and Justin Lee Wray, of Mt. Morris, New York, were charged in Dauphin County with Medicaid fraud, theft by deception, tampering with public records, and criminal conspiracy. Mausteller was employed as a direct care worker for his mother, Wray, and submitted claims for services he did not provide. Medicaid paid $9,775 for fraudulently billed services.

Western Pennsylvania

Monet Guidry and Tameia Cooper, of Pittsburgh, were charged in Allegheny County with Medicaid fraud and theft by deception. Cooper was employed as a personal care attendant for Guidry’s grandmother, but billed for time she was working at other jobs. Medicaid paid $4,708 for the fraudulent submissions.

Stephanie Nichols, of Pittsburgh, was charged in Allegheny County with Medicaid fraud and theft by deception for billing time as a personal care attendant when the care recipient was receiving dialysis and not in her car. Medicaid paid $4,347 for the fraudulent claims submitted by Nichols.

James Page, of Pittsburgh, was charged in Allegheny County with Medicaid fraud and theft by deception for submitting time sheets as a personal care attendant during which Page was working at another job. Medicaid paid $13,179 to Page for the fraudulent claims.

The cases are being prosecuted by attorneys in the Medicaid Fraud Control Section: Senior Deputy Attorney Generals Elizabeth Madigan, Jeffrey Baxter, Eric Stryd and Jason Karasik, and Deputy Attorney Generals Edward Song and Christopher Jason.

Original source can be found here.

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