Today, August 4, 2026, federal and state officials announced significant health care fraud enforcement actions involving Pennsylvania’s Medicaid home care system. The announcement is expected to receive considerable media attention and signals increased scrutiny of home and community-based services providers, caregivers, participants, and billing practices.
The Pennsylvania Office of Attorney General filed criminal charges against two personal care attendants accused of submitting nearly $1.4 million in improper Medicaid claims. The allegations include billing for overlapping services and reporting more than 24 hours of care in a single day.
Separately, the U.S. Department of Justice announced charges against 19 individuals, including home care company owners and employees, caregivers, and Medicaid participants, for their alleged involvement in schemes representing more than $4 million in Medicare and Medicaid claims. The allegations include billing for services that were not provided, claims submitted while caregivers or participants were incarcerated or hospitalized, services reportedly provided while caregivers were working other jobs or traveling outside the country, and false electronic clock-in and clock-out records.
DOJ also announced the expansion of its Northeast Health Care Fraud Strike Force into Philadelphia. The new Philadelphia operation will coordinate the work of federal prosecutors, the Pennsylvania Office of Attorney General, the FBI, the HHS Office of Inspector General, the DEA, and other enforcement partners. This expansion represents a substantial increase in the federal resources focused on health care fraud in Pennsylvania.
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While the allegations involve a limited number of individuals and must be proven through the legal process, today’s announcement reinforces a broader reality: Medicaid program integrity will remain a major priority for both Pennsylvania and the federal government.
RCPA members, particularly organizations providing personal assistance, home care, and other community-based services, are encouraged to review their internal controls related to electronic visit verification, employee and participant scheduling, overlapping shifts, out-of-state service records, authorization compliance, billing reconciliation, and the timely investigation of unusual claims patterns. Providers should also ensure that staff understand their responsibility to report suspected misconduct and that concerns are documented, investigated, and addressed promptly.
RCPA will continue to monitor these cases and the activities of the expanded Northeast Health Care Fraud Strike Force, including any broader implications for provider oversight, audits, managed care requirements, and Pennsylvania Medicaid policy. Charges and allegations referenced in the announcements are not findings of guilt, and all defendants are presumed innocent unless proven guilty.
If you have any questions, please contact
Fady Sahhar.
