HARRISBURG, PA — In a tale of lies and deception, a Philadelphia man has been found guilty of defrauding Medicaid to the tune of more than $4,200. Felipe L. Santos was convicted of claiming payment for home care hours he couldn’t possibly have worked – because the patient he was supposed to be caring for was in the hospital.
The shocking scam came to light after a two-day trial, during which a Montgomery County jury heard how Santos had reported providing care for his mother-in-law between October 2020 and May 2021. The only problem? His mother-in-law was hospitalized at Aria-Jefferson Hospital, Frankford Campus, and Temple University Hospital during the times he claimed to be looking after her.
Santos, 30, now faces the serious consequences of his actions. He was convicted of four counts each of Medicaid fraud, tampering with public records, and theft by deception – all felonies. A sentencing date is set to be determined in May.
“Prosecuting these crimes is vital to maintaining the integrity of a healthcare system that helps Pennsylvanians receive care,” said Attorney General Michelle Henry. “This defendant intentionally defrauded the system and is now held accountable thanks to the tenacious work of our investigators and prosecutors.”
The fraudulent scheme unfolded when Santos submitted his claimed hours to Philadelphia-based home care agency Help at Home. Unaware of the deceit, Help at Home sought reimbursement from PA Health and Wellness, a Medicaid-funded managed care organization.
The Office of Attorney General’s investigation revealed that Santos had claimed at least 262.5 hours he could not have worked, leading to Medicaid (through PA Health and Wellness) shelling out at least $4,297.74 for services that were never rendered.
Senior Deputy Attorney General Jason Karasik was the prosecutor on this case, ensuring that justice was served and that those who attempt to exploit the healthcare system for their gain are held accountable.
As the dust settles on this case, it serves as a stark reminder of the importance of vigilance and integrity in our healthcare system. Medicaid is a lifeline for many Pennsylvanians, and those who seek to defraud it will face the full force of the law.
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