MM Curator summary
[MM Curator Summary]: The scammers paid staff to go into poor neighborhoods to get Medicaid IDs so they could submit false claims. You paid about $4M in tax dollars for this one.
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RALEIGH, N.C. – A Greensboro, North Carolina woman, Sharita Mathis Richardson, was sentenced today to 22 months in prison and three years of supervised release for conspiracy to commit health care fraud. On March 25, 2021, Richardson pleaded guilty to the charge. As part of sentencing, Richardson was also ordered to pay $2,005,531 in criminal restitution to the North Carolina Fund for Medical Assistance.
“This defendant conspired with others to steal millions in federal funding intended to provide health care to those in need,” said U.S. Attorney Michael Easley. “Our office will continue to bring those who abuse and misuse taxpayer funds to justice.”
According to court documents and other information presented in court, between approximately 2012 and 2016, Richardson conspired with Antonio Fozard and others to defraud the North Carolina Medicaid system through the submission of over $4 million in false and fraudulent claims for the reimbursement of behavioral health services. Medicaid is a federally funded health care benefit program that helps pay for medical-related services for low-income individuals and their families. In North Carolina, Medicaid is administered by the North Carolina Department of Health and Human Services, Division of Health Benefits.
Fozard owned and operated a number of behavioral health companies that purported to provide services to Medicaid beneficiaries in the Middle and Eastern Districts of North Carolina. These companies included Group Service, Inc., and Zoofari Kids, LLC. Each of these entities engaged in a systematic effort to steal from Medicaid by billing for services that were never rendered.
Group Service maintained offices at various times in Raleigh, Dunn, Durham, and Sanford. Among other things, Group Service employed Reginald Van Reese, Jr., and Ruben Samuel Matos to canvas low-income neighborhoods to identify eligible Medicaid recipients and collect their personal identifying information (PII), including their Medicaid Identification numbers. The harvested PII was then incorporated into false and fraudulent claims that Group Service submitted to Medicaid for reimbursement. Note writers, including Humberto Mercado, were also enlisted to fabricate supporting documentation in the event of a Medicaid audit. Richardson held herself out as Group Service’s chief operating officer and assisted Fozard in the day-to-day operations of the criminal enterprise.
During much of the same time period, Fozard and Richardson were also managing members of Zoofari Kids, which was similarly defrauding the North Carolina Medicaid system. Zoofari Kids operated in Durham and Garner. The Durham location shared the same address as Group Service and purported to provide mental health treatment to Medicaid recipients. The Garner location was strictly a drop-in daycare facility. The daycare, however, was effectively funded by Medicaid fraud proceeds paid out to Zoofari’s mental health business.
Fozard, Reese, Matos, and Mercado each pleaded guilty to conspiracy to commit health care fraud in separate related cases. Reese, Matos, and Mercado were previously sentenced to terms of imprisonment and ordered to pay restitution to the North Carolina Fund for Medical Assistance. Fozard is scheduled to be sentenced during the term of court that begins on July 20, 2022.
Michael Easley, United States Attorney for the Eastern District of North Carolina, made the announcement after sentencing by United States District Judge Louise W. Flanagan. The Federal Bureau of Investigation and the Medicaid Investigations Division of the North Carolina Department of Justice investigated the case. Assistant United States Attorney Adam F. Hulbig prosecuted the case for the government.
Related court documents and information can be found on the website of the U.S. District Court for the Eastern District of North Carolina or on PACER by searching for Case No. 5:20-CR-506-FL.
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Clipped from: https://www.justice.gov/usao-ednc/pr/greensboro-resident-sentenced-conspiring-defraud-north-carolina-medicaid-system