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 is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.