$70 MILLION in Medicaid home healthcare fraud schemes exposed in New York

Multi-million-dollar Medicaid home healthcare fraud schemes have been cropping up in New York City, with two cases in the news just since the new year, highlighting a pattern of abuse from fraudsters in the system.

On January 15, Manal Wasef, 46, and Elaine Antao, 46, both pleaded guilty to a $68 million adult daycare fraud scheme, where they conspired to defraud Medicaid through kickback payments for services that were not provided at a home healthcare company and two adult daycares in the city.

“The defendants were large-scale recruiters who bribed patients with laundered cash and billed Medicaid over $68 million for services that were not provided,” said Assistant Attorney General A. Tysen Duva of the Justice Department’s Criminal Division. “Today’s guilty pleas demonstrate the Department’s longstanding commitment to rooting out fraud in government health care programs by aggressively prosecuting those who steal from taxpayer-funded programs.”

According to charges, both Wasef and Antao were marketers and recruiters for multiple companies and, "between approximately October 2017 and July 2024, in exchange for illegal kickbacks and bribes, Wasef and Antao referred Medicaid recipients to the social adult day cares and the home health company. The defendants also paid illegal kickbacks and bribes to Medicaid recipients for social adult day care services and home health care services that were billed to Medicaid but were not provided or that were induced by kickbacks and bribes," the DOJ stated.

Additionally, the sentence of James Bessell, Sr., 65, of Shirley, New York was announced. He had stolen by way of fraud over $1 million from Medicaid "by taking advantage of vulnerable New Yorkers through fake billing and kickback schemes," a press release about the case said. Bessell had been the owner and operator of a transportation company known as Jim Jim Rentals, Inc. He claimed the funds through submitting fraudulent claims to Medicaid for transporting patients who were discovered to be deceased, in prison, or in the hospital.

The pattern of fraud is not new in New York, and there has been healthcare-related fraud in the past.

NewsNation reported that New York’s Consumer Directed Personal Assistance Program (CDPAP), which allows patients to allow family members or relatives to be their caretaker in their own home, has been a frequent “target of sophisticated scammers.”

This comes as the Trump administration has been zooming in on the issue of fraud in other states as well. The issue of fraud was brought into the national spotlight after independent reporter Nick Shirley broke a massive report showing alleged fraud taking place at Somali-run daycare centers in Minnesota.

New York Governor Kathy Hochul has previously called an audit of the CDPAP program introduced by Republicans a "political stunt."