DOJ Charges 19 Defendants in Alleged $4 Million Philadelphia Medicare and Medicaid Fraud

The defendants include home health aides and Medicaid recipients, including those with significant criminal records.

Published: 8/4/2026, 1:48:36 PM EDT

DOJ Charges 19 Defendants in Alleged $4 Million Philadelphia Medicare and Medicaid Fraud — A Medicare Advantage PPO card sits on top of a Medicare card, in this file photo. (Jenny Kane/AP)

19 people have been charged in an alleged scheme that defrauded Pennsylvania's Medicaid program of more than $4 million, marking another takedown of major health care fraud in the country, according to federal and state officials.

During a press conference Tuesday, authorities said the offenders allegedly targeted home health care services in the state meant to support the most vulnerable Americans.

18 of the defendants were charged in the last 12 days as part of a strategically coordinated law enforcement operation between the fraud division, the U.S. attorney’s office, and the Pennsylvania attorney’s office, according to Colin McDonald, assistant attorney general with the Justice Department’s National Fraud Enforcement Division.

The defendants include home health aides and Medicaid recipients, including those with significant criminal records. Additionally, owners of a home health agency that allegedly participated in the fraud have been charged, McDonald said.

He pointed out that Pennsylvania is one of the highest spenders for home care services in the nation, exceeding $8 billion in spending in 2025 alone.

The exploited programs are supposed to help the elderly live with dignity in their own home instead of leaving their families.

"The case is today billed on the work that we recently announced in Minnesota, where we charged 15 defendants for systematically looting seven state-managed Medicaid programs out of more than $90 million, treating those programs like a piggy bank until one of them had to be shut down entirely because there was nothing left. The shelves were empty,” McDonald said.

Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services (CMS), pointed out that more than 96 percent of personal care claims in Pennsylvania are coded as "illness unspecified." He argued that this lack of specific diagnostic information makes it difficult for CMS to track the services being provided and detect improper billing. Based on this pattern, Oz said it points to fraud and indicates the need for closer scrutiny of these claims.

The Justice Department’s National Fraud Enforcement Division also announced a major expansion of its Northeast Health Care Fraud Strike Force to Philadelphia, partnering with the U.S. Attorney’s Office for the Eastern District of Pennsylvania to combat Medicaid fraud. Nationally, the Strike Force has prosecuted more than 6,200 defendants who collectively billed over $45 billion to federal health care programs and private insurers.

During Tuesday's press conference, Deputy CMS Administrator Kimberly Brandt also provided an update on the health care fraud crackdown in California, announcing that 1,076 hospices have been removed from the Medicare program in California alone since President Donald Trump took office.

“These are hospices that are no longer under review. They’re not on a watch list. They are GONE; thrown out of the program entirely—unable to bill Medicare, unable to touch another taxpayer dollar, unable to take advantage of another vulnerable beneficiary,” Brandt said.