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Rimersburg Man Charged in Medicaid Billing Fraud Scheme Enters Guilty Plea

Friday, February 5, 2021 @ 12:02 AM

Posted by Aly Delp

GavelCLARION CO., Pa. (EYT) – A Rimersburg man charged in a Medicaid fraud scheme entered a guilty plea in court on Wednesday.

On Wednesday, February 3, 48-year-old David Joseph Young entered a guilty plea on the following charges in Clarion County Court of Common Pleas:

– Forgery, Misdemeanor 1
– Conspiracy – Forgery, Misdemeanor 1

– Tampering With Public Records, Misdemeanor 2
– Conspiracy – Tampering With Public Records, Misdemeanor 2

Sentencing for the case is scheduled for March 3.

Young remains free on $5,000.00 unsecured bail.

The charges stem from an investigation initiated by the Pennsylvania Office of Attorney General’s office.

Details of the case:

According to a criminal complaint, on October 23, 2018, the Pennsylvania Office of Attorney General’s office opened an investigation into Mitzy Sue Ealy over allegations of Medicaid Fraud based on information from the Bureau of Program Integrity (BPI).

The complaint states the BPI reported they received information that Personal Care Assistants (PCAs) for a Medical Assistance consumer, identified as David Joseph Young, were splitting money received from Public Partnerships Limited (PPL) for personal care services they were not actually rendered.

According to the complaint, it was determined that Ealy was one of Young’s PCAs from September 11, 2017, to September 12, 2018. It was also determined that on two occasions, Ealy was in the hospital, despite billing PPL for attendant services rendered to Young.

Ealy allegedly billed PPS for working with Young from 8:00 a.m. to 6:00 p.m. on January 22, 2018, while documents from Butler Memorial Hospital later showed that Ealy was in the Emergency Room from 12:35 p.m. to 6:23 p.m., which confirmed that Ealy billed 5.41 hours to PPL for services she could not have rendered to Young.

Ealy also allegedly reported to PPL that she worked with Young from 8:00 a.m. to 6:00 p.m. on April 8, 2018, while documents from Armstrong County Memorial Hospital later showed that Ealy was in the Emergency Room from 10:49 a.m. to 1:21 p.m., which confirmed that Ealy billed 2.53 hours to PPL for services she could not have rendered to Young.

An investigator for the Pennsylvania Office of Attorney General’s office then interviewed Ealy.

According to the complaint, Ealy admitted that she only worked with Young for four or five hours per day, despite her and Young billing PPL for numerous days over five hours. Ealy also allegedly admitted that she split $1,100.00 to $1,200.00 from her PPL paycheck with Young every two weeks.

Ealy told the investigator that her employment with Young as his PCA was under the pretense that she would provide Young with money from the PPL checks she received for the personal attendant services she was purportedly rendering, and she allegedly stated that she viewed the PCA program as a means of making some extra money for herself while also helping Young make additional money, as well, according to the complaint.

The investigator also interviewed Young regarding the alleged fraud.

According to the complaint, Young approximated that Ealy only worked three to five hours per day, despite days when he and Ealy billed PPL for more. He also allegedly confirmed that he approached his attendants, including Ealy, with the offer of a job as his PCA under the pretense that they would agree to split the money they received with him, adding that it was a way for all of them to make extra money.

The complaint states calculations of the fraud totals for Ealy using Ealy’s statements determined that between September 29, 2017, and September 12, 2018, Ealy and Young billed PPL for 1,254 hours of personal attendant service which were not actually completed. Based on Ealy’s PPL billing summary, it was found that PPL paid Ealy $11.37 per hour, resulting in PPL, and therefore Medicaid, paying Ealy $14,257.98 for services she did not actually render.

Case Against Travis Runyan

According to the complaint, the investigator also determined that Travis Carl Runyan, who was a PCA for Young from September 24, 2018, to July 6, 2019, billed PPL for personal care services to Young despite Young receiving medical services at Clarion Hospital.

The complaint notes Young was a patient at Clarion Hospital on April 23, 2019, from 10:53 a.m. to 2:53 p.m. despite Runyan also billing PPL for personal care services he reported to have rendered to Young the same day from 7:00 a.m. to 5:00 p.m.

The investigator interviewed Runyan, who allegedly admitted he only worked for Young four or fewer days every week, despite he and Young billing PPL for more days. The complaint states a later review of Runyan’s PPL timesheet determined that Runyan and Young billed PPL for seven days per week from September 30, 2018, through July 6, 2019, the complaint indicates.

Runyan allegedly admitted he provided $400 to Young from each PPL paycheck that he received, according to the complaint.

When questioned, Young approximated that Runyan only actually provided personal attendant services to him for about ten percent of the hours they billed to PPL, and also said that Runyan put in “a minimal amount of work overall,” the complaint states.

Calculations of the fraud totals for Runyan using Runyan’s statements regarding his work times determined that Runyan and Young billed PPL for 840 hours of personal attendant services, which Runyan did not actually work. Based on Runyan’s PPL billing summary, PPL paid Runyan $11 per hour for 42 of the identified hours and $11.32 per hour for 798 of the identified hours resulting in PPL, and therefore Medicaid, paying Runyan $9,495.26 for services he did not actually render, according to the complaint.

Young and Mitzy Sue Ealy, 34, of Parker, were arraigned in front of Judge Miller on the charges on June 26.

Travis Carl Runyan, 29, of Rimersburg was arraigned in front of Judge Miller on July 13.

Ealy was entered into the Accelerated Rehabilitative Disposition (ARD) Program for two years on December 2, 2020, on the following charges:

– False/Fraudulent Medical Assistance Claim, Felony 3
– Conspiracy – False/Fraudulent Medical Assistance Claim, Felony 3
– Theft By Deception-False Impression, Felony 3
– Conspiracy – Theft By Deception-False Impression, Felony 3

Travis was entered into the Accelerated Rehabilitative Disposition (ARD) Program for six months on February 3, on the following charges:

– False/Fraudulent Medical Assistance Claim, Felony 3
– Conspiracy – False/Fraudulent Medical Assistance Claim, Felony 3
– Theft By Deception-False Impression, Felony 3
– Conspiracy – Theft By Deception-False Impression, Felony 3


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