The Justice Department (DOJ) announced on August 4, 2026, that it has charged 19 individuals in connection with alleged schemes in the Philadelphia area that resulted in over $4 million in fraudulent Medicare and Medicaid claims. The defendants include home health aides, Medicaid recipients, and owners and employees of home care companies. The DOJ claims that some individuals billed Medicaid for services that were not provided, including care claimed during periods when aides or recipients were incarcerated, hospitalized, traveling, or employed elsewhere.
The announcement coincided with the expansion of the Northeast Health Care Fraud Strike Force into Philadelphia, a partnership between the DOJ’s National Fraud Enforcement Division and the U.S. Attorney’s Office for the Eastern District of Pennsylvania. Assistant Attorney General Colin M. McDonald stated that the funding for home care is intended to assist vulnerable populations, not to support fraudulent activities.
Nationally, the Health Care Fraud Strike Force has prosecuted over 6,200 defendants who collectively billed more than $45 billion to federal healthcare programs and private insurers. In the Philadelphia cases, allegations include four defendants submitting over $440,000 in claims for services that did not occur and one individual billing for home care while traveling overseas.
Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, highlighted concerns regarding Pennsylvania's personal-care billing data, noting that the state ranks fifth in average monthly payments per beneficiary and provider. He indicated that over 96% of personal care claims in Pennsylvania are coded as 'illness unspecified,' complicating the tracking of services and detection of improper billing.
Tom Jones, president of the American Accountability Foundation, suggested that the scrutiny applied in the Philadelphia cases should extend to applied behavior analysis (ABA) providers serving autistic patients, citing concerns over inflated billings and fraudulent filings in that sector. The DOJ's recent expansion follows similar growth in California, Arizona, Nevada, Massachusetts, and Minnesota, with significant alleged losses identified in previous years.