In a move to crack down on fraudulent practices, the state attorney general’s office has taken action against two individuals accused of exploiting Medicaid services. A former case manager in Luzerne County has been charged with billing Medicaid for numerous therapy sessions that never occurred, while a former mental health therapist in Lycoming County faces charges of sexual exploitation and fraudulent billing.
“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 emphasized in a statement released on Tuesday.
Both Michael Erik Miller, 36, from Williamsport, and Khalil Rashid Rivera, 30, from Scranton, have been released on unsecured bail following the charges.
Extensive Fraud in Luzerne County
A statewide grand jury has revealed that Khalil Rashid Rivera submitted nearly 1,300 false Medicaid claims for therapy sessions with children from March 2019 to August 2022. The investigation began after a family reported not having seen Rivera for over a year, despite ongoing billing for his services.
Rivera, who worked as a blended case manager at the Children’s Service Center, was responsible for connecting children with mental health services. However, an internal review found discrepancies between Rivera’s claimed interactions and the agency’s records, such as using copy-pasted progress notes for multiple clients.
In one specific instance, Rivera filed identical progress notes for a client on two separate dates, despite not having visited the client since Christmas 2021. Investigators discovered numerous encounter forms either missing or improperly filled out, further supporting the fraudulent billing allegations.
Phone Records Uncover Deception
Phone records played a crucial role in the investigation into Rivera’s activities. Analysis revealed that he billed for thousands of service units corresponding to calls that either never occurred or were shorter than reported. The fraudulent claims totalled over $72,000 in Medicaid funds.
Rivera is now facing multiple felony charges, including submitting fraudulent claims and tampering with public records.
Lycoming County Therapist’s Misconduct
Michael Erik Miller, who worked as an unlicensed therapist at Lycoming Therapeutic Wraparound Services Inc., is accused of exploiting a female client while also committing Medicaid fraud. According to court documents, Miller engaged in inappropriate behavior during therapy sessions, which included sexual contact and drug use with the client.
The therapist’s misconduct was detailed in an affidavit by supervisory special agent Jennifer E. Snerr, which described a pattern of boundary violations and manipulative behavior. The client reported fearing that Miller would drop her if she did not comply with his advances.
Miller’s actions resulted in Medicaid being billed over $7,000 for services that reportedly included unethical conduct. He faces charges of Medicaid fraud, sexual extortion, and other related offenses.
