North Carolina Providers Must Pay $3 Million for Medicaid Fraud

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North Carolina’s Medicaid program is the purported winner in two cases that wrapped up this week. The two defendants, both mental health providers, were sentenced separately in federal court on charges of Medicaid fraud. Their sentences were handed down earlier this week.

In the first case, the U.S. District Court judge sentenced the defendant, a 49-year-old woman, to 92 months in federal prison. He also ordered her to repay the state’s Medicaid program more than $1 million and to pay the Internal Revenue Service $145,197.

According to the U.S. Attorney, the defendant filed for Medicaid reimbursement for services she did not provide. Some of the clients named in the claims had never received care while others were no longer in her care.

Prosecutors added that some of the defendant’s claims showed she provided services for more than 24 hours a day, at times as much as 80 hours a day. The defendant also allegedly submitted claims for services provided in August 2009, although she¬†was incarcerated at the time.

Authorities say she used the money to purchase a number of vehicles, including a Bentley and a Hummer.

The charges in this case included health care fraud, money laundering, failure to file tax returns and possession of a firearm by a convicted felon.

In the second case, the defendant, a 49-year-old man, will spend 15 months in prison and pay $1.9 million to the state. The U.S. Attorney charged the man with conspiracy to commit health care fraud. According to prosecutors, the defendant and a co-conspirator submitted claims for services provided by unlicensed and Medicaid-ineligible mental health workers.

Source: News & Observer, “2 Charlotte residents ordered to repay $3M in Medicaid fraud sentencing,” Lynn Bonner, Oct. 21, 2011