A case manager at the Children’s Services Center in Wilkes-Barre has been charged with filing dozens of fraudulent claims and defrauding Medicare of more than $72,000, according to the Pennsylvania Office of Attorney General.
Khalil Rashid Rivera, 30, of Scranton, was working as a blended case manager at the center at 335 S. Franklin St. when he billed Medical Assistance for services he never provided to dozens of children, prosecutors said.
Rivera’s case and another involving a former counselor in Lycoming County were recently highlighted in the U.S. Department of Justice’s National Health Care Fraud Takedown initiative, which has resulted in 324 arrests involving an alleged $14.6 billion in fraud.
“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,” Attorney General Dave Sunday said in a statement. “These bad actors cannot be allowed to harm their patients and steal from a healthcare system that is depended on by so many Pennsylvanians.”
Prosecutors said the 51st Statewide Investigating Grand Jury recommended charges against Rivera, who was accused in January 2023 of failing to see patients, including one family that was neglected for nearly a year.
The charges allege that Rivera billed Medicaid for visiting clients at their homes and other locations, when in fact his work badge and the building access log revealed he was in his office during the relevant times.
Multiple families reported not seeing Rivera for extended periods and that the time between visits was growing longer and longer, prosecutors said.
Rivera also began having families sign multiple visitation forms at a time, creating a paper trail for visits that never happened, according to prosecutors.
The charges allege Rivera ultimately billed thousands of fraudulent claims for 54 different clients, resulting in the overpayment of more than $72,000.
Court records show Rivera is charged with felony counts of filing fraudulent medical assistance claims, submitting false claims, theft and tampering with public records.
Magisterial District Judge Rick Cronauer arraigned Rivera on the charges and released him on $10,000 unsecured bail. A preliminary hearing was scheduled for Aug. 11.
In the Lycoming County case, prosecutors said 36-year-old Michael E. Miller is accused of sexually extorting a patient and billing for the sessions in which he engaged in sexual acts.
Sunday said the nationwide enforcement effort resulted in charges against 96 doctors, nurse practitioners, pharmacists and other medical professionals.
The case was investigated by the Department of Justice Criminal Division’s Fraud Section along with the U.S. Attorney’s Office, the Department of Health and Human Services, the FBI and the Drug Enforcement Administration.