Pennsylvania Healthcare Workers Charged in National Medicaid Fraud Crackdown

Two Pennsylvania healthcare workers are now facing criminal charges as part of a massive national crackdown on Medicaid fraud. The cases—one involving sexual exploitation of a patient and the other involving false billing for children’s services—highlight a troubling pattern of abuse and exploitation by individuals entrusted with the care of vulnerable populations.

At KBD Attorneys, we believe patients deserve better. These disturbing stories emphasize the urgent need for accountability and legal action when healthcare providers cross ethical and legal lines. Our firm represents victims of healthcare fraud, abuse, and neglect throughout Pennsylvania, and we are committed to protecting families and holding bad actors accountable.

In this blog post, we break down what happened in these cases, what they mean for the community, and how victims and their families can pursue justice.

Source: MSN

Case #1: Former Counselor Accused of Sexual Exploitation and Medicaid Fraud

In Lycoming County, Michael E. Miller, a 36-year-old former counselor, was charged with sexually exploiting a patient and submitting fraudulent Medicaid claims totaling over $7,000. According to the Pennsylvania Office of Attorney General, Miller engaged in an ongoing pattern of inappropriate behavior between July 2023 and February 2024, which included:

• Physical touching during therapy sessions

• Sharing personal, boundary-crossing information

• Visiting the patient’s home and engaging in sexual acts

• Smoking marijuana and showering with the patient

Investigators allege that Miller manipulated the patient into believing her access to care depended on her compliance with his advances. This exploitation of power is not only unethical but criminal, especially when combined with the submission of false claims to Medical Assistance (Pennsylvania’s Medicaid program).

This case was referred by the Pennsylvania Department of State and is now being prosecuted by the Medicaid Fraud Control Unit, alongside federal partners like the FBI and Department of Health and Human Services Office of Inspector General.

Case #2: Blended Case Manager Accused of $72,000 in Fraudulent Billing

In a separate case in Luzerne County, Khalil Rashid Rivera, 30, is accused of billing Medicaid for services he never provided to dozens of children. Rivera worked as a blended case manager at a children’s services center, a role that involves coordinating and delivering mental and behavioral health services to young clients and their families.

Allegations emerged after a family reported they hadn’t seen Rivera in almost a year, despite ongoing billing activity. An internal audit uncovered glaring inconsistencies between Rivera’s reported visits and his office badge access logs, suggesting he wasn’t present during many of the supposed appointments. Families also recalled being asked to sign documentation for services they never received—sometimes months after the fact.

In total, Rivera is alleged to have committed more than $72,000 in Medicaid fraud, affecting 54 children.

A National Pattern of Abuse and Fraud

These cases are part of a larger effort led by the U.S. Department of Justice to combat healthcare fraud across the nation. Dubbed the 2024 National Health Care Fraud Takedown, the operation targeted 324 defendants and involved over $14.6 billion in intended losses. Charges were brought against a wide range of medical professionals, including:

• Physicians

• Nurse practitioners

• Pharmacists

• Behavioral health workers

• Other licensed caregivers

While these charges represent only a fraction of the fraud occurring nationwide, they send a strong message: fraud, abuse, and exploitation in healthcare will not be tolerated.

Why Medicaid Fraud Matters to Pennsylvania Families

Healthcare fraud doesn’t just affect government agencies—it hurts real people. In cases like these, the true cost includes:

• Vulnerable patients being manipulated or harmed

• Children being denied essential services

• Families losing trust in the medical system

• Taxpayer money being stolen or misused

For patients and families who rely on Medicaid and behavioral health services, this kind of abuse can be devastating. It can lead to untreated conditions, trauma, and loss of faith in professionals who are supposed to help.

Legal Options for Victims of Healthcare Abuse or Fraud

At KBD Attorneys, we fight for victims of medical misconduct, healthcare fraud, and provider abuse. When trusted professionals commit crimes under the guise of care, civil lawsuits can help survivors seek justice and recover damages.

If you or your loved one was exploited by a counselor, therapist, caseworker, or another healthcare provider, you may have legal grounds to sue for:

• Sexual exploitation or assault

• Fraudulent billing for services not received

• Negligent hiring or supervision by the agency

• Emotional distress and psychological harm

• Financial restitution for lost or misused Medicaid funds

In addition to pursuing criminal charges, victims can pursue civil claims for compensation, particularly when agencies fail to properly screen, train, or monitor employees.

How KBD Attorneys Can Help

Our firm is experienced in investigating and handling complex healthcare misconduct and fraud cases across Pennsylvania. We understand how traumatic these experiences can be for patients and families—especially when the victims are children or vulnerable adults.

KBD Attorneys can help by:

• Conducting a confidential case review

• Investigating billing and provider records

• Holding agencies accountable for negligent hiring or oversight

• Working with state and federal investigators when appropriate

• Filing civil lawsuits for damages and accountability

We are committed to ensuring that wrongdoers are held accountable, not just by the justice system but in the civil courts as well.

Protecting Your Family from Healthcare Fraud

If your loved one receives services through Medicaid, it’s important to:

• Review all Explanation of Benefits (EOB) statements

• Keep a record of all appointments and provider interactions

• Speak up if something feels wrong or unprofessional

• Report suspected fraud to the Pennsylvania Office of Attorney General or the Medicaid Fraud Control Unit

And if you believe your loved one was harmed or exploited by a healthcare provider, don’t hesitate to contact KBD Attorneys for a free, confidential consultation.

Conclusion: Fraud and Exploitation Must Be Confronted

The recent charges against two Pennsylvania healthcare workers are a wake-up call. Fraud and abuse don’t just waste public funds—they hurt real people. At KBD Attorneys, we’re here to help families affected by healthcare misconduct seek justice and secure accountability.

If you suspect you or someone you love was the victim of healthcare fraud or abuse, contact us today. We serve clients across Philadelphia, Pittsburgh, Allentown, Erie, and throughout Pennsylvania, and we are ready to stand by your side.

We also have offices in Maryland, Florida, Massachusetts, and North Carolina

KBD Attorneys | Protecting Patients. Fighting Fraud. Pursuing Justice.

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