(STL.News) – A resident of Pittsburgh, Pennsylvania, pleaded guilty in federal court yesterday to one count each of conspiracy to defraud the Pennsylvania Medicaid program and health care fraud, United States Attorney Scott W. Brady announced today.
Keith Scoggins, 54, pleaded guilty before United States District Judge Cathy Bissoon.
During his plea hearing, Scoggins admitted that between 2011 and 2017 he was an employee of Moriarty Consultants, Inc. (MCI), one of four related entities operating in the home health care industry. The other three entities were Activity Daily Living Services, Inc. (ADL), Coordination Care, Inc. (CCI), and Everyday People Staffing, Inc. (EPS). MCI, ADL, and CCI were approved under the Pennsylvania Medicaid program to offer certain services to qualifying Medicaid recipients (“consumers”), including personal assistance services (PAS), service coordination, and non-medical transportation, among other services. Between in and around January 2011 and in and around April 2017, MCI, ADL, and CCI, collectively, received more than $87,000,000 in Medicaid payments based on claims submitted for these services, with PAS payments accounting for more than $80,000,000 of the total amount.
During that time, Scoggins, who was employed in a supervisory position as PAS Director, admitted that he participated in a wide-ranging conspiracy to defraud the Pennsylvania Medicaid program for the purpose of obtaining millions of dollars in illegal Medicaid payments through the submission of fraudulent claims for services that were never provided to the consumers identified on the claims, or for which there was insufficient or fabricated documentation to support the claims. As part of the conspiracy, Scoggins admitted that he fabricated timesheets to reflect the provision of in-home PAS care that, in fact, he never provided to the consumer identified on the timesheets. Scoggins further admitted that he caused the submission of Medicaid claims in the name of a “ghost” employee—a close relative—for PAS care that was never provided to the consumer specified on the claims. Likewise, Scoggins admitted that he paid kickbacks to a consumer, totaling approximately $160 every two weeks, in exchange for the consumer’s cooperation in the fraudulent billing scheme. In total, Scoggins admitted causing losses to the Pennsylvania Medicaid program in excess of $100,000.
Judge Bissoon scheduled Scoggins’s sentencing for 2:15 p.m. on May 5, 2020.
The conspiracy and health care fraud charges each carry a maximum total sentence of not more than 10 years in prison, a fine of $250,000, or both. Under the Federal Sentencing Guidelines, the actual sentence imposed would be based upon the seriousness of the offense and the prior criminal history, if any, of the defendant.
To date, a total of sixteen defendants have been charged in connection with this investigation. Scoggins is the ninth defendant to enter a guilty plea. The remaining defendants are presumed innocent unless and until proven guilty.
Assistant United States Attorneys Eric G. Olshan and Special Assistant United States Attorney Edward Song are prosecuting this case on behalf of the government. The Federal Bureau of Investigation, Pennsylvania Office of the Attorney General – Medicaid Fraud Control Unit, Internal Revenue Service – Criminal Investigation, U.S. Department of Health and Human Services – Office of Inspector General, and United States Postal Inspection Service conducted the investigation of the defendants.