A Fall from Grace

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a pregnant woman waiting in hospital , sitting in the waiting room and chatting to a doctor with a young nurse in the background.

A Greensboro, N.C. woman has been sentenced after participating in a scheme that defrauded the North Carolina Medicaid program out of hundreds of thousands of dollars. Things started going south for this fraudster when she decided to misrepresent her business affairs.

Pamela Grace Faulkner, 60, owned and operated Skeen Services, Inc., an authorized partner with the North Carolina Medicaid program that had offices Greensboro, Greenville, Lumberton, and Wilson. (By all accounts, she was a successful businesswoman before her fall from grace.)  

Faulkner’s co-conspirator, Renee Christine Borunda, knowingly submitted over 4,500 fraudulent claims to Medicaid over the course of 2013 and 2014. These claims falsely asserted that Skeen Services had provided behavioral health services to over 190 North Carolinians. None of the services listed on the claims had been provided. (As if the government wasn’t going to check to make sure they actually did their job.)  

Faulkner was fully aware that Borunda was making these claims on behalf of Skeen Services. The duo hatched a plan where they agreed to split the money they received from Medicaid. In total, Skeen Services fraudulently received approximately $213,927 in reimbursements for the false claims. 

The funds were electronically deposited into an account controlled by Faulkner. Borunda was paid approximately $144,000 by Faulkner for her role in the scheme. (I wonder what she spent all that money on.)

Borunda was previously sentenced on November 7, 2018, to 37 months in federal prison followed by 3 years of supervised release for Conspiracy to Commit Healthcare Fraud and Aggravated Identity Theft.

Faulkner was also sentenced to 37 months in prison for Conspiracy to Commit Healthcare Fraud. She was also ordered to pay restitution in the amount of $213,927.55 to the North Carolina Medicaid program. This is money that should have been used to help struggling North Carolina residents. Instead, it accumulated in the bank account of two fraudsters who did not deserve it. (Fortunately, they got what they deserved in the end.)

Today’s Fraud of the Day comes from a Department of Justice press release, “Corporate Officer Sentenced to Prison for Medicaid Fraud,” dated March 30, 2021.

NEW BERN, N.C. – A Greensboro woman was sentenced today to 37 months in prison and also ordered to make restitution in the amount of $ 213,927.55 to the North Carolina Medicaid program for Conspiracy to Commit Health Care Fraud.

According to court documents, Pamela Grace Faulkner, 60, was the sole officer of Skeen Services, Inc., which was a company with offices in Greensboro, Greenville, Lumberton, and Wilson, North Carolina. In 2013 and 2014, Faulkner’s co-conspirator, Renee Christine Borunda, submitted over 4,500 fraudulent claims to Medicaid which falsely represented that behavioral health services had been provided to over 190 North Carolinians when in fact the services had not been provided. Faulkner was aware that Borunda was submitting the false claims.  They had agreed to split the monies from the fraudulent claims.  Medicaid paid Skeen Services, Inc. approximately $213,927.55 for these false claims by electronically depositing the funds into an account over which Faulkner had control.  Faulkner then paid Borunda approximately $144,000.

 

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.