Delaware County Personal-Care Aide: Billing for Care While the Patient Was in the Hospital

The Pennsylvania Attorney General’s Office described a Delaware County Medicaid home care fraud case in which a personal-care aide allegedly submitted more than 400 hours for a patient who was hospitalized. For someone who handles home-care schedules, attendance or billing, the contradiction is immediate: the claimed care puts the patient at home while the patient is in a hospital bed.

What Pennsylvania Reported

The office’s March 17, 2025 account of its criminal cases reported that the aide pleaded no contest to Medicaid fraud. The office said he submitted fraudulent hours for personal care he claimed to be providing during the patient’s hospitalization.

We see something particularly brazen in billing for hands-on care while the patient is somewhere else receiving treatment. The paperwork describes a visit that the patient’s actual whereabouts contradict. Medicaid exists to fund care for people who need it, and a claim for invented care asks taxpayers to pay for a service the patient never received.

Why the Patient’s Location Matters to the Claim

A hospital stay gives the claimed home-care hours something concrete to be tested against. Someone handling schedules may recognize that a claimed visit overlaps a hospital admission. Someone handling billing may understand how the hours reached a claim. Connecting those views makes the allegation specific: whose care, whose time, which service and which payment.

Medicaid Personal Care Runs on Authorized Tasks and Hours

Medicaid personal-care payment connects authorized tasks, reported time, service units and payer rates. State-plan personal care calls for authorized services and a worker qualified to provide them.

For an insider, the useful connection runs from the care the patient was authorized to receive, through the hours attributed to a worker, to the claim and payment. A patient’s continuing need for help cannot supply the missing visit.

In self-directed personal assistance, the participant can schedule and supervise workers and approve invoices, while a financial management service helps with payment. The person who knows whether care happened and the organization handling the money can therefore see different parts of the same transaction. Financial management assistance does not replace the participant’s authority over the workers. That division matters when the approved invoice and the claimed visit tell different stories.

What Evidence Is Needed to Prove Fraud?

We assess that with the insider, using their knowledge of the patient’s hospital stay and the personal-care hours submitted for the same period. We trace the discrepancy through the service records, the resulting claims and the people responsible for them.

The Department of Health and Human Services Office of Inspector General explained in its 2016 personal-care fraud advisory why paperwork alone can conceal unperformed care. It described pre-signed timesheets, travel overseas and services supposedly occurring in different places at the same time.

That is why firsthand knowledge belongs alongside the records. A timesheet can appear complete while someone who knows the patient or worker can explain why the entry could not be true. We examine how that knowledge connects to what the payer was told and what it paid.

Hospitalization Billing Has Also Produced a Civil Whistleblower Case

In a case brought by whistleblowers, 1st Adult & Pediatrics Healthcare Services agreed to a $3 million civil settlement over allegations that it billed Medicaid for in-home pediatric services during hospitalization and for services it did not provide. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. For an insider who recognizes hours that could not have been worked, we assess how the underlying facts and claims fit a civil whistleblower case.

You Know Where the Patient Was

If you know home-care hours were claimed while the patient was hospitalized, speak to one of our whistleblower experts about the hours billed. We work with you to build your strongest Medicaid whistleblower case, bring in Medicaid fraud whistleblower lawyers who understand personal-care billing, and stay with you through the case.