When one thinks of North Carolina, they normally think of southern hospitality and sweet tea. However, there are a few folks who didn’t get the memo and could work on their manners a bit more. Ruben Samuel Matos, of Angier, has been sentenced for his role in a conspiracy to commit health care fraud.
Between 2014 and 2017, Matos conspired with multiple individuals and businesses to defraud the North Carolina Medicaid system. Matos and his co-conspirators fraudulently submitted over $3.6 million in false and fraudulent claims for the reimbursement of behavioral health services. (Sounds like he actually needs some behavioral services.)
Matos partnered with Reginald Van Reese, Jr., of Raleigh, who was previously convicted of conspiracy in a similar case. (Looks like he didn’t learn his lesson the first time around.) As part of the scheme, Matos and Reese canvassed low-income neighborhoods to identify eligible Medicaid recipients and collect their personal information, including Medicaid identification numbers. (These scammers took advantage of the nation’s most vulnerable citizens and your tax dollars. That should make you pretty mad.)
Matos and Reese took the collected beneficiary information and sold it to behavioral health business operators. Those operators then submitted fraudulent claims to Medicaid for reimbursement of services that were never rendered. (Everyone wanted to get paid to do nothing instead of helping the medically underserved.)
They also worked with another co-conspirator, Antonio Deon Fozard, of Durham. Fozard controlled multiple behavioral health entities, including ‘Group Service’ and ‘In Touch of Care’. Fozard, Matos, and Reese defrauded the North Carolina Medicaid system by using stolen beneficiary information to bill Medicaid in the name of these two companies.
To substantiate their claims in the event of an audit, the trio enlisted ”note writers’ who forged medical documentation. These documents falsely asserted that beneficiaries had been evaluated and that the medical services Medicaid was billed for had been performed.
In furtherance of a similar Medicaid fraud scheme, Matos and Reese later partnered with Luis Angel Lozada, of Clayton. He owned and operated Cornerstone Family Services Group. According to the investigation, Cornerstone also used stolen Medicaid beneficiary and clinician data to back-bill the Medicaid system. (Birds of a feather flock together.)
Matos was sentenced to 42 months in prison and three years of supervised release. As part of sentencing, Matos was also ordered to pay $1,997,883 in criminal restitution to the North Carolina Fund for Medical Assistance.
Antonio Fozard and Luis Lozada pleaded guilty to health care fraud charges in the U.S. District Court for the Eastern District of North Carolina and are currently awaiting sentencing.
Today’s Fraud of the Day comes from a Department of Justice press release, ”Angier, NC Resident Sentenced for Conspiring to Defraud the North Carolina Medicaid System,” dated August 18, 2021.
NEW BERN, N.C. – An Angier, North Carolina man, Ruben Samuel Matos, was sentenced today to 42 months in prison and three years of supervised release for conspiracy to commit health care fraud. On September 18, 2020, Matos pled guilty to the charge. As part of sentencing, Matos was also ordered to pay $1,997,883 in criminal restitution to the North Carolina Fund for Medical Assistance.
According to court documents and other information presented in court, between 2014 and 2017, Matos conspired with multiple individuals and businesses to defraud the North Carolina Medicaid system by submitting over $3.6 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.