North Carolina Medicaid Fraud – 40 Months in Prison

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Leader Of Medicaid Fraud Conspiracy Sentenced To 40 Months In Prison For $336,000 Healthcare Fraud & Money Laundering

 

United States Attorney Anne M. Tompkins Western District of North Carolina

Fifteen Others Convicted Of Related State And Federal Charges

STATESVILLE, N.C. – An Alleghany Co. woman was sentenced on Monday, May 6, 2013 to serve 40 months in prison and two years of supervised release for health care fraud conspiracy and money laundering, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina.

U.S. Attorney Tompkins is joined in making today’s announcement by Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Division (MID); Derrick Jackson, Special Agent in Charge, Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region; and Jeannine A. Hammett, Special Agent in Charge of the Internal Revenue Service, Criminal Investigation Division (IRS-CI).

Betty Ann Cook, 56, of Sparta, N.C., pleaded guilty on April 25, 2012, to one count of health care fraud conspiracy and one count of money laundering conspiracy. According to court documents and court proceedings, Cook was the owner of Families First Home Health Care, a home health care company located in Alleghany Co., N.C. Cook’s company was enrolled with Medicaid to provide personal care services (“PCS”) such as bathing, dressing, and eating to Medicaid recipients. These types of services are provided by a home health aide in the recipient’s home. According to filed documents, from December 2006 to about October 2010, Cook participated in a scheme to defraud Medicaid by submitting false and fraudulent claims to Medicaid seeking reimbursement for patient care services that were either not provided, not authorized by a physician, or were not based upon a valid in-home eligibility assessment performed by a qualified registered nurse, as required by Medicaid policy.

Court records indicate that during the relevant time period, Cook and her co-conspirators, which included PCS aides and Medicaid recipients, participated in a “fee-splitting” scheme. The scheme involved billing Medicaid for patient care services that were not rendered and then splitting the fraudulently obtained Medicaid reimbursements among the co-conspirators. As a result of the fee-splitting scheme, Cook received over $150,000 as payment to the fraudulent claims.

In addition to the fee-splitting scheme, court documents reveal that Cook also submitted fraudulent claims to Medicaid for patient care services allegedly provided to Medicaid recipients, even though the services were not approved by a physician. Cook copied, altered and falsified physician signatures on forms in order to justify the fraudulent billing. In some instances, Cook altered the forms approving PCS for a Medicaid recipient, despite a physician’s clear denial of such services. Similarly, Cook and her co-conspirators submitted fraudulent claims for PCS based upon false and fraudulent nurse assessments, by forging nurses’ signatures on PCS assessment forms.

At the sentencing hearing, U.S. District Judge Richard L. Vorhees also ordered Cook to pay $325,820.17 in restitution. Cook has been released on bond since entering her guilty plea. She will be ordered to report to a federal facility, at which time she will be transferred into the custody of the Federal Bureau of Prisons. Federal sentences are served without the possibility of parole.

Monday’s sentencing of Cook marks the conclusion of a multi-year investigation into Cook and her conspirators. In addition to Cook, 15 other individuals have been convicted in federal and state court in related charges. On April 8, 2013, Crystal Deleon Evans, 34, of Sparta, was sentenced to probation for one count of health care fraud conspiracy. Fourteen other individuals have pleaded guilty in the Allegheny County District Court to misdemeanor charges of conspiracy to commit Medicaid fraud. Those individuals, listed below, all were sentenced to probationary terms.

• Jessica Beth Absher-Shelton, 33, of Anderson, S.C.
• Patricia Atkins, 62, of Low Gap, N.C.
• Billie Jo Bingman, 34, of Sparta.
• Crystal Brewster, 34, of Sparta.
• Lisa Marie Cook, 35, of Sparta.
• Rena Mahan, 32, of Sparta.
• Desiree Payne, 22, of Sparta.
• Dwana Sanchez, 36, of Sparta.
• Tammy Williams, 43, of Laurel Springs, N.C.
• Jessica Cook, 27, of Sparta.
• Dietra Michelle Bottomley, 38, of Ennice, N.C.
• Tammy Atkins, 43, of Mount Airy, N.C.
• Amy Lyall, 39, of Sparta.
• Deborah Aroche, 49, of Sparta.

The investigation into Cook and Evans was handled by MID, HHS-OIG and IRS-CI, assisted by the North Carolina Division of Medical Assistance and the Alleghany County Sherriff’s Office. The prosecution was handled by Special Assistant United States Attorney Laura Lansford and Assistant U.S. Attorney Kelli Ferry of the Western District of North Carolina.

Ms. Lansford is an Assistant Attorney General with the North Carolina Department of Justice Medicaid Investigations Division and was appointed to serve as a Special Assistant United States Attorney (SAUSA) with the U.S. Attorney’s Office in Charlotte in 2007. The SAUSA position is reflection of the partnership between the Medicaid Investigations Division and the United States Attorney that helps ensure the effective and vigorous prosecution of Medicaid fraud.

The investigation and charges are the work of the Western District’s joint Health Care Fraud Task Force. The Task Force is multi-agency team of experienced federal and state investigators, working in conjunction with criminal and civil Assistant United States Attorneys, dedicated to identifying and prosecuting those who defraud the health care system, and reducing the potential for health care fraud in the future. The Task Force focuses on the coordination of cases, information sharing, identification of trends in health care fraud throughout the region, staffing of all whistle blower complaints, and the creation of investigative teams so that individual agencies may focus their unique areas of expertise on investigations. The Task Force builds upon existing partnerships between the agencies and its work reflects a heightened effort to reduce fraud and recover taxpayer dollars.

If you suspect Medicare or Medicaid fraud please report it by phone at 1-800-447- 8477 (1-800-HHS-TIPS), or E-Mail at HHSTips@oig.hhs.gov. To report Medicaid fraud in North Carolina, call the North Carolina Medicaid Investigations Division at 919-881-2320.

 

 

 

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