A Philly home care worker pocketed thousands in a Medicaid scam, playing the system while his patient was actually cooped up in a hospital bed, authorities said yesterday.
Felipe L. Santos, a 30-year-old from the City of Brotherly Love, was anything but caring as he bilked Medicaid for over $4,200, falsely claiming he was tending to his mother-in-law at home when she was nowhere near her living room, instead, lay in a hospital room suffering at Aria-Jefferson Hospital, Frankford Campus, and Temple University Hospital, according to Attorney General Michelle Henry in a statement.
A Montgomery County jury saw through Santos' scheme yesterday, convicting him on four counts each of Medicaid fraud and tampering with public records, and theft by deception after a brief two-day trial highlighted his dishonesty.
Henry hailed the verdict, saying "This defendant intentionally defrauded the system and is now held accountable thanks to the tenacious work of our investigators and prosecutors," and signaling a win for healthcare integrity, the conviction comes down hard on a man who submitted bogus hours to Philadelphia home care agency Help at Home, causing them to unwittingly request reimbursement from PA Health and Wellness, a Medicaid-funded managed care organization.
The defendant claimed he gave care for at least 262.5 hours between October 2020 and May 2021, hours during which his mother-in-law was hospitalized, as the Attorney General's investigation exposed, leading to Medicaid (through PA Health and Wellness) shelling out at least $4,297.74 on his false claims.
Senior Deputy Attorney General Jason Karasik prosecuted the fraudster, ensuring Santos will face a judge's sentence on an undetermined date come May, while the Pennsylvania Medicaid Fraud Control Unit, bankrolled by both federal and state dollars, continues its watchdog role with a Federal fiscal year 2024 budget of over $10 million from the U.S. Department of Health and Human Services, supplemented by more than $3.5 million from the state of Pennsylvania.
