Pittsburgh, PA (PPP)—An investigation by the Pennsylvania Attorney General’s Medicaid Fraud Control Section alleges that a personal care attendant submitted fraudulent time sheets to the state’s Medicaid program. The attendant is accused of claiming to have provided care to a client when they were actually working another job or not providing care at all. The investigation began after the client’s family reported discrepancies in the time sheets.

The investigation found that the attendant submitted over 100 fraudulent time sheets, resulting in over $7,000 in improper payments from the Medicaid program. The attendant has been charged with multiple counts of Medicaid fraud and theft by deception. If convicted, they could face up to seven years in prison and fines of up to $15,000. The Attorney General’s office is urging anyone who suspects Medicaid fraud to report it to their office.

Name: Desiree R. Green
Gender: Female
Age: 51

Agency: Pennsylvania Office of the Attorney General

Court: Magisterial District Court 05-02-36
Docket Number: MJ-05236-CR-0000033-2023
Date Filed: February 24, 2023

Criminal Charges

1. False/Fraud Med Assist Claim
2. Theft by deception – False Impression

Affidavit of Probable Cause

Your Affiant, Tyler Henk, is employed as a Special Agent with the Pennsylvania Office of Attorney General, Bureau of Criminal Investigations. Your Affiant is currently assigned to the Medicaid Fraud Control Section (“MFCS”) in the Western Regional Office located in North Huntingdon, Pennsylvania.

Your Affiant was assigned to investigate allegations that, among other things, Personal Care Attendant (“PCA”) Desiree GREEN had defrauded the Pennsylvania Medical Assistance (“Medicaid”) Program by causing false information to be submitted to and paid by the Pennsylvania Medicaid Program for services that GREEN did not render to Pennsylvania Medicaid recipient ███████.

In the course of Your Affiant’s duties as a Special Agent with the MFCS, Your Affiant has become familiar with the operation of the Pennsylvania Department of Human Services (“OHS”) Medicaid Program and the Medicaid reimbursement system.

The Pennsylvania Medical Assistance (“Medicaid”) Program

The Pennsylvania Medical Assistance Program, also known as Medicaid, is a joint State/Federal program that purchases health care for low-income Pennsylvania residents with certain disabilities. This Program is administered by the Office of Medical Assistance Programs (“OMAP”) within the Pennsylvania OHS.

The Medicaid Personal Care Attendant Program

Pennsylvania’s PCA Program provides for basic and ancillary services that enable an eligible person to remain in his/her home and community rather than being admitted to an institution, and to assist him/her in carrying out functions of daily living, self-care and mobility.

In some cases, Medicaid-enrolled Personal Assistance Service (“PAS”) agencies are hired by Medicaid recipients to provide PCAs who render services in the recipients’ homes under the “Agency Model,” for which Medicaid pays.

DHS Medicaid providers participating in this program receive money from the Pennsylvania Medicaid Program to pay for PAS rendered by the PCAs. The Medicaid provider agencies receive Medicaid Waiver consumer-employee timesheets from individuals working as PCAs for PAS that they purportedly perform. The providers, relying on the integrity of these timesheets, then pay the PCA for the services utilizing Medicaid Program money.

In the Consumer Model, Medicaid allows recipients to directly hire a PCA using Medicaid-contracted Public Partnerships, LLC (“PPL”) to act as the financial intermediary in facilitating the filing of claims and the payment of Medicaid funds to the PCA based on timesheets a PCA submits to PPL.

The Case against Desiree GREEN

1. On June 11, 2021, the Pennsylvania Office of Attorney General (“OAG”) MFCS opened an investigation involving fraudulent claims submitted to the Pennsylvania OHS through the Medical Assistance Program. The allegation was provided by UPMC for You (“UPMC and/or the MCO”) In this case, UPMC is a Managed Care Organization that acted as an additional financial intermediary between Medicaid public funds and the Defendant. Despite the intermediaries, all of the money involved in this case comes from Medicaid.
2. The initial allegation was that PCA Desiree GREEN continued to submit timesheets to PPL after her last day of work as a PCA for consumer ███████. According to Medicaid Documents, the work in this case was supposed to have occurred at 7048 Fleury Way, Pittsburgh PA 15208 in Allegheny County. While investigating this, the fraud outlined in this affidavit was uncovered.
3. Your affiant viewed the timesheets GREEN submitted to PPL They reflected that she worked for ███████ from either 10a-4p or 10a-5p, Monday through Friday, totaling 6 or 7 hours per day.
4. Your affiant obtained and reviewed the timesheet records GREEN submitted to PPL and to a second Medicaid Provider, JEVS, from April 15, 2019 through March 19, 2020. In doing so, your affiant found that GREEN provided timesheets claiming to be performing work in two (2) places at the same time. Your affiant found 165 instances when GREEN submitted timesheets to PPL and JEVS at the same time resulting 884.53 hours of overlap.
5. During an interview with GREEN on November 1, 2022, GREEN confirmed that she was the PCA with PPL for ███████. GREEN acknowledged that she signed the PPL timesheets and was aware that timesheets were being submitted for hours that she did not work and that she was subsequently paid. Your affiant showed GREEN an example of a completed PPL timesheet and she identified it as a timesheet that was submitted on her behalf. GREEN relayed that she never informed PPL that she was getting paid for the hours not being worked. GREEN advised that she was paid via direct deposit by PPL and admitted that she gave money to ███████ from her PPL paycheck for the days she did not work. GREEN advised that by doing this, she thought she was helping ███████ out GREEN acknowledged that she got paid for the all the days that were submitted on the PPL timesheets. GREEN confirmed that she worked for JEVS Care at Home (JEVS) as a caregiver for numerous consumers during the same time period she was working for ███████. Your affiant informed GREEN that an employment overlap analysis was conducted and it was discovered that timesheets were submitted to PPL and JEVS, resulting in overlapping times. Your affiant informed GREEN that she could not be at two (2) places at once. GREEN agreed that you definitely can’t be in two (2) places at once. GREEN confirmed that all the times she submitted with JEVS were 100% accurate.
6. Your affiant added the number of hours that overlapped from both PPL and JEVS over the span of the 165 instances. This number represents the total fraudulent hours submitted for this Medicaid Fraud Scheme. The total fraudulent hours were multiplied by GREEN’s PPL hourly wage of $11.51 to calculate the total fraud loss of $10,180.94 ($11.51 x 884.53). This is what Green was paid and slightly lower than what Medicaid paid as the intermediaries are paid a percentage of the Medicaid disbursement.

Breakdown of Fraudulent Activity:

1. Total hours billed for time frame April 15, 2019 through March 19, 2020: 1,562
2. Investigation confirmed that GREEN fraudulently billed for 884.53 hours and was paid at $11.51 per hour equaling $10,180.94
3. The Managed Care Organization (MCO), UPMC, paid out approximately $11,162.77 of Medicaid money. (884.53 hours at $12.62 per hour, which equates to $11,162.77)

In summation, from April 15, 2019 through March 19, 2020, GREEN billed Public Partnership, LLC 884.53 hours of work that she knew was not performed. As a result of these fraudulent timesheet submissions, GREEN was paid $10,180.94 of Medicaid Funds to which she was not entitled.

Based upon the above facts, your affiant respectfully requests the following charges: Medicaid Fraud (Provider Prohibited Acts) (Title 62, 1407 (A)1) and Theft by Deception (Title 18, 3922 (A)1).