Attorney General Michelle Henry today announced that, based upon recommendations from the 47th Statewide Investigating Grand Jury, a Berks County-based home care agency and its owner have been charged with claiming nearly half a million dollars in Medicaid reimbursement for services that were never performed.
Following Investigating Grand Jury proceedings, A Part of Our Family Home Care Agency and owner Gavin Mata were charged Tuesday with Medicaid Fraud, Theft, and related offenses. Bail was set at $100,000 unsecured.
Between January 2020 and April 2022, the Medical Assistance program paid A Part of Our Family $488,349 for services that were never provided. Some of the reported clients had never signed up for or received care from A Part of Our Family, and agency employees were not aware Mata had reported these services.
“Medicaid is a lifeline to essential services for low-income Pennsylvanians, and this agency exploited the system to defraud and steal for personal interests,” AG Henry said. “Criminals who defraud Medicaid are targeting our most vulnerable Pennsylvanians, who trust their caregivers to look out for them, and all hard-working Pennsylvania taxpayers.”
A Part of Our Family Home Care Agency and Mata were each charged with four counts of Medicaid Fraud, one count of Theft by Deception, and six counts of Tampering with Public Records.
Mata, 36, of New York, also is charged with four counts of Identity Theft, and a single count of Perjury.
It is alleged that Mata manipulated time sheets and other documents to align with the scheme. The forms lacked clients’ signatures and the employees reportedly performing the work told investigators they had not done so, and were unaware of the reported hours.
Mata then lied under oath during Grand Jury testimony about the agency’s payroll records.
The investigation revealed that A Part of Our Family billed three Medical Assistance-funded managed care organizations: PA Health and Wellness, UPMC Health Plans, and AmeriHealth, for services that were never provided. The organization also submitted claims that inflated the hours of services provided.
In all, A Part of Our Family received over $488,349 from Medical Assistance for non-existent services.
All charges are accusations. The defendants are innocent unless and until proven guilty.
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 $9,781,180 for Federal fiscal year (FY) 2023. The remaining 25 percent, totaling $3,260,392 for FY 2023, is funded by Pennsylvania.