Putting a Stop to Fraud

Cropped shot of a medical professional filling out paperwork

More than 2.1 million residents of North Carolina receive Medicaid benefits. (Just so you know, that’s about 20 percent of the state’s population.) The government healthcare program and taxpayers took a $900,000 hit when a Durham woman used her two mental health businesses to carry out a Medicaid fraud scheme that impacted a variety of victims who are poor, elderly and disabled.

The woman in today’s fraud case operated two mental health businesses in the Durham area of North Carolina. One of the mental health businesses was actually a shell company registered to an empty office in nearby Raleigh, yet this location was responsible for submitting thousands of false claims related to mental health services that were never delivered. The other business was responsible for submitting claims involving one clinician who purportedly conducted more than 24 one-hour counseling sessions in a day.

Over three years, today’s fraudster used the personal information of Medicaid beneficiaries to submit fraudulent claims to the government healthcare program. (She stole that personally identifiable information and used it to line her pockets with $900,000. The fraudster also used stolen identities of clinicians to bill under their provider codes.)

The 57-year-old from Durham pleaded guilty to Medicaid fraud and was sentenced to 46 months in prison and three years of supervised release for filing false claims. She is also required to pay $523,783 in restitution and surrender multiple real estate properties in Raleigh, Durham and Orlando. A co-conspirator was previously convicted and is currently serving 40 months in prison.

The North Carolina-based mental health provider sounds like she needs some mental health care herself. Under the guise of providing mental health services to some of the nation’s most vulnerable citizens, she stole resources from the people who need care the most, not to mention honest taxpayers. Congrats to the U.S. Attorney’s Office for the Eastern District of North Carolina for putting a stop to this fraudster’s abusive practices.

Today’s “Fraud of the Day” is based on an article, Durham woman gets nearly four years in federal prison for Medicaid scam,” published by the Carolina Journal on February 15, 2019.

A Durham woman is going to federal prison for bilking the Medicaid system out of more than $900,000, U.S. Attorney Robert Higdon announced on Friday.

U.S. District Court Judge Louise Flanagan sentenced Tamara Perry McCaffity, 57, to 46 months in prison followed by three years of supervised release for filing false claims for reimbursement. She was ordered to make $523,783 in restitution and surrender real estate properties on Empire Lakes Drive in Raleigh, Elmridge Court in Durham, and in Orlando, Florida.

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Larry Benson
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.