North Carolina Department of Justice
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Medicaid fraud sweep nets 18 arrests, AG Cooper says

Release date: 12/19/2011

Suspects alleged to have billed for medical services they didn’t provide, more arrests expected

Greensboro:  Eighteen health care providers accused of defrauding taxpayers and the Medicaid system were arrested last week as the start of a major statewide sweep, Attorney General Roy Cooper announced Monday.
The 18 individuals were arrested in 10 different counties for engaging in various schemes to defraud the North Carolina Medical Assistance Program (Medicaid).  Criminal charges levied against these health care providers include Obtaining Property by False Pretenses and Medicaid Provider Fraud.  The charges allege more than half a million dollars in fraudulent payments. 
“Our investigators, agents and prosecutors are working harder and smarter than ever before to go after Medicaid cheaters and stop the fraud,” Cooper said
Health care providers arrested Thursday, December 15 include mental health workers, group home operators, personal care aides and agency heads, a speech therapist and a registered nurse. So far, law enforcement has carried out busts in Alleghany, Cumberland, Gaston, Guilford, Harnett, Hertford, Pitt, Robeson, Union, and Wake counties with more arrests expected in the weeks and months ahead. 
Two more suspects were charged as part of the sweep and are expected to be arrested soon. The suspects are thought to be in Georgia and Iowa, and North Carolina’s Medicaid Investigations Unit is working with law enforcement in those states to locate and arrest the suspects. One of the 18 suspects arrested Thursday has already pleaded guilty and paid restitution. See the case summary for details on each case.
The state is pursing criminal convictions as well as restitution of money from the accused. 
To date, 16 different law enforcement agencies and 12 District Attorney’s Offices as well as the Division of Medical Assistance of the N.C. Department of Health and Human Services have assisted in the operation.
This latest crackdown on fraud is made possible by a recent expansion of the Attorney General’s Medicaid Investigation Unit (MIU). The MIU has nearly doubled in size since last year with the addition of new attorneys, investigators, criminal information analysts and support staff. 
With the added staff have come major changes in how the unit goes after fraud. Members of the MIU have been organized into investigative teams that include intelligence analysts, financial investigators, SBI agents, and civil and criminal attorneys. The teams are able to work more effectively and efficiently to uncover possible fraud, search complex records, track down evidence in the field, and prosecute cases in court.
“Ripping off Medicaid hurts needy patients, wastes taxpayer money, and drives up health care costs,” Cooper said. “We’re sending a strong signal to those who defraud Medicaid that we will find you and make you pay.”
North Carolina’s MIU has recouped more than $440 million over the past decade and helped to convict more than 470 individuals on criminal charges including patient abuse and neglect as well as financial fraud.    During the federal fiscal year that ended September 30, 2011, the MIU won 22 criminal convictions and 18 civil settlements that recovered $49,104,823.95 from Medicaid abusers.
The Attorney General’s MIU investigates fraud and abuse of Medicaid benefits by hospitals, doctors, pharmaceutical companies, medical equipment companies, mental health and personal care providers, ambulance services and others. The MIU also investigates patient abuse and neglect in nursing homes and other Medicaid-funded facilities. The unit works closely with United States Attorneys, District Attorneys, and other state and federal law enforcement agencies.

  Contact:  Noelle Talley, (919) 716-6413