Medicaid Recipient Claimed Round-The-Clock Home Care While Secretly Working as a Carpenter, DOJ Alleges

A Medicaid recipient who claimed to need round-the-clock home health care is alleged to have been secretly working as a carpenter, the US Department of Justice said on Tuesday, as it announced new fraud charges linked to more than £3.1 million ($4 million) in bogus Medicare and Medicaid claims.

Nineteen defendants, including health care company owners and purported aides, face federal and state charges in connection with schemes totalling more than £3.1 million ($4 million) in claims submitted to Medicare and Medicaid. These public health programmes are designed to protect vulnerable citizens, and prosecutors said the alleged conduct misused taxpayer-funded resources.

The announcement followed the official expansion of the Northeast Health Care Fraud Strike Force into Philadelphia to address billing abuses. The law enforcement operation outlined an alleged network of phantom care, describing how taxpayer-funded state resources were allegedly diverted through fabricated working hours.

Discovering Impossible Medicaid Billing Hours

Investigators reported discrepancies in timesheets submitted by care providers in the region. According to a Justice Department release, aides billed Medicaid for providing services while they were actually incarcerated, hospitalised, working different jobs or travelling overseas.

In some cases, workers claimed to be providing care for more than twenty-four hours in a single day. One home care agency and its owners face federal charges for allegedly billing Medicaid with false clock-in and clock-out data.

'The partnership between the Fraud Division and the Eastern District of Pennsylvania will uniquely enable law enforcement to combat criminals who hide behind corporations to commit fraud,' the Justice Department said in a published statement. Officials said they would use all available legal tools to investigate those cheating the public.

A History of Illicit Billing

Pennsylvania Attorney General Dave Sunday confirmed a separate plea agreement this week involving the final defendant in a previously charged case. That earlier investigation dismantled a twenty-one-person operation tied to more than £1.3 million ($1.7 million) in bogus claims.

Officials said the case illustrated how far such operations can extend before they are uncovered. The probe focused on home- and community-based services that prosecutors said were billed but not provided as claimed. Authorities said lessons from that investigation are now informing how newer fraud cases are identified and pursued.

The Philadelphia strike force office will now work with the FBI, the Drug Enforcement Administration and the Department of Health and Human Services Office of Inspector General. The local expansion is part of a broader nationwide strategy to address improper medical billing.

Strike Forces Focus on Medicaid and Medicare Fraud

Health care fraud has been identified by authorities as a continuing problem across the country. National enforcement actions have targeted schemes involving more than £11.7 billion ($15 billion) in alleged losses in 2025 and a further £4.7 billion ($6 billion) in 2026 alone. Strike forces have recently been launched in states including California, Arizona, Nevada, Massachusetts and Minnesota.

As the expanded strike force begins its work in Philadelphia, authorities are preparing to pursue further alleged fraudulent claims. The individual who allegedly worked as a carpenter while claiming the need for extensive home health assistance is among those charged, alongside home care agency owners accused of submitting claims for care that was not provided.