“Ghost” Employee; Real Scam

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Happy young woman and her cute son looking at doctor and listening to his recommendations

A Pennsylvania Personal Assistance Services director pleaded guilty to participating in a massive Medicaid fraud scheme. His plea included one count of conspiracy to defraud the Pennsylvania Medicaid program and one count of healthcare fraud.

Keith Scroggins, who worked for Moriarty Consultants, Inc., submitted fraudulent claims for services to the Pennsylvania Medicaid program. Services were never provided to the Medicaid recipients identified on the claims or claims were submitted with insufficient or fabricated documentation.

Scroggins created fraudulent timesheets, and even identified a close relative as a “ghost” employee of his company, billing phony claims under his name. He also paid kickbacks to a Medicaid recipient in exchange for cooperation.

Scroggins cost the Pennsylvania Medicaid program (and taxpayers) more than $100,000. With sentencing scheduled in May 2020, he could face up to 10 years in prison, a fine of $250,000, or both for his Medicaid fraud scheme. Scroggins’ activities were part of a massive conspiracy, with 16 defendants charged, and nine pleading guilty to date. (Looks like he’ll have plenty of friends to keep him company if he goes to prison.)

Today’s Fraud of the Day comes from a news release from the United States Attorney’s Office, Western District of Pennsylvania, “Pittsburgh Resident Pleads Guilty to Conspiracy and Health Fraud,” published Jan. 14, 2020.

PITTSBURGH, Pa. – 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.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.