HARRISBURG, PA — Two Pennsylvania men are facing serious allegations of defrauding the Medicaid system as part of a sweeping national law enforcement operation targeting health care fraud, officials announced Tuesday.
The cases, brought forward by the Pennsylvania Office of Attorney General and featured in the U.S. Department of Justice’s National Health Care Fraud Takedown, involve accusations against a former counselor in Lycoming County and a case manager in Luzerne County.
Attorney General Dave Sunday described the charges as part of a broader effort to combat fraudulent practices that undermine public trust and drain critical resources. “These cases are not instances of mistaken billing — they involve providers who were criminally unprofessional, and in some cases, predatory, towards people they were trusted to care for,” Sunday said.
In the first case, 36-year-old Michael E. Miller, a former counselor, is accused of sexually exploiting a patient during counseling sessions between July 2023 and February 2024. Prosecutors allege that Miller engaged in repeated inappropriate contact, including physical touching and disclosing personal details that crossed professional boundaries. Authorities say Miller even visited the patient’s home, where he reportedly smoked marijuana with her, showered alongside her, and engaged in sexual acts.
Investigators learned the patient feared that refusing Miller’s advances would jeopardize her access to therapy. Over the course of these interactions, Miller allegedly submitted fraudulent claims totaling more than $7,000 to Medical Assistance. The case was referred to the Attorney General’s Office by the Pennsylvania Department of State.
In the second case, Khalil Rashid Rivera, 30, a blended case manager with a children’s services center in Luzerne County, is accused of billing Medicaid for services he never provided to dozens of children. The allegations surfaced after a family reported not having seen Rivera for nearly a year despite ongoing billing records.
An internal review revealed discrepancies between Rivera’s reported visits and his office badge access logs. Families also recounted that visits became less frequent or stopped altogether, yet they were asked to sign multiple forms retroactively. In total, Rivera is accused of fraudulently billing for services related to 54 clients, resulting in more than $72,000 in improper payments.
The national operation, coordinated by the Department of Justice’s Health Care Fraud Unit, targeted 324 defendants across the country, involving an alleged $14.6 billion in intended losses. Actions were brought against a wide range of medical professionals, including doctors, nurse practitioners, pharmacists, and other caregivers.
Attorney General Sunday stressed the importance of holding accountable those who abuse their positions of trust. “These bad actors cannot be allowed to harm their patients and steal from a healthcare system that is depended on by so many Pennsylvanians,” he said.
The cases against Miller and Rivera are being prosecuted by the Pennsylvania Office of Attorney General’s Medicaid Fraud Control Unit, in partnership with federal agencies including the Department of Health and Human Services Office of Inspector General and the Federal Bureau of Investigation.
All criminal charges are allegations, and both Miller and Rivera are presumed innocent until proven guilty in a court of law.
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