Medicaid Raid

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Criminals are well aware that Medicaid fraud can be a serious money-maker, and they don’t appear deterred by the consequences. A press release published by the U.S. Attorney General’s office details how members of a Medicaid fraud ring in North Carolina would stop at nothing to cover their tracks, and now four of them are serving multiple years behind bars.

According to the press release, the members of this ring worked at a business that purported to specialize in Medicaid reimbursement and the operation of mental health clinics. (That’s quite a broad array of services for just one clinic to offer.)But it actually was just a fraud factory with co-conspirators for employees, who spent their days concocting Medicaid patient records for fake companies, so they could submit fake claims for reimbursement. (”Honey, did that rash really warrant a CAT scan?”) Eventually, it got to the point when one person was fabricating files while another was destroying them, in a feeble attempt to keep their stories straight in the face of investigators.

All in all, the group attempted to obtain $1.6 million in fraudulent Medicaid reimbursement claims, but all have been caught. Two will serve at least two years in prison and together must pay $370,372.70 in restitution. Another was sentenced to 28 months in prison and must pay back $352,565.69. A fourth will serve 33 months in prison and must repay Medicaid $392,159.81. All four will each serve three years of probation, following their release from prison.

Source: Today’s ”Fraud of the Day” is based on, ”Fayetteville, N.C. Woman Responsible For Creating Fake Patient Files In Medicaid Fraud Conspiracy Is Sentenced Prison,” a press release published by the U.S. Attorney General’s office on April 18, 2016.

According to information in filed court documents and today’s sentencing hearing, between October 2012 and August 2013, Melvin was involved in a Medicaid fraud conspiracy organized by the ring’s leader, Cynthia Harlan. Harlan owned and operated ”Heartland Consulting and Marketing, Inc.,” a Charlotte-area company, purportedly specializing in the operation of mental health companies and Medicaid reimbursement. According to court records, Harlan executed a Medicaid fraud scheme involving the fraudulent submission of fake reimbursement claims to Medicaid for services that were never actually provided to beneficiaries. Court records show that Harlan relied on a network of conspirators, including Melvin, whom she had recruited to carry out the scheme.

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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.