Tuesday, October 30, 2012

North Carolina Woman Admits to a $6.1 Million Medicaid Scheme That Targeted Children

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A North Carolina woman pleaded guilty on September 14, 2012, for her involvement in a health care scheme that allegedly defrauded Medicaid from 2008 to 2011 for fake mental and behavior health services. Through this scheme, she allegedly obtained at least $6.1 million in fraudulent reimbursement payments, according to the Federal Bureau of Investigation (FBI).

Click here to see the press release from the FBI.

Medicaid Beneficiaries Were Primarily Children.
An article in the Gaston Gazette stated the former licensed professional counselor, who was enrolled with North Carolina Medicaid, allegedly claimed in the fraudulent billings that she was the attending clinician for provided services. The woman also allegedly supervised a network of co-conspirators who billed for false and fraudulent claims through the woman’s provider number.

To read the entire article from the Gaston Gazette, click here.

According to the FBI, filed documents indicate that the claimed Medicaid beneficiaries were primarily children, whose parents thought they were enrolling in after school programs owned and operated by the woman and her co-conspirators.

Woman Pleaded Guilty.
According to the FBI, the woman pleaded guilty to one count of health care fraud conspiracy and two counts of money laundering. She faces 10 years in prison and a $250,000 fine apiece for the health care fraud conspiracy and money laundering charges.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits.Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don't wait until it's too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.  Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

FBI. “Shelby Woman Pleads Guilty to Defrauding Medicaid of $6.1 Million.” FBI Charlotte Division. (September 13, 2012). From: http://www.fbi.gov/charlotte/press-releases/2012/shelby-woman-pleads-guilty-to-defrauding-medicaid-of-6.1-million

Banks, Alicia. “Judge Candidate’s Wife Admits to $6.1 Million Fraud.” Gaston Gazette. (September 14, 2012). From:

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

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