An Alleghany Co. woman charged with health care fraud conspiracy and money laundering conspiracy has pled guilty to those charges today, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina.
U.S. Attorney Tompkins is joined in making today’s announcement by Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Unit (MIU); Derrick Jackson, Special Agent in Charge, Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region; and Jeannine A. Hammett, Special Agent in Charge of the Internal Revenue Service, Criminal Investigation Division (IRS-CI).
…from about December 2006 to about October 2010, Cook participated in a scheme to defraud Medicaid by submitting false and fraudulent claims to Medicaid seeking reimbursement for patient care services that were either not provided, or not authorized by a physician, or were not based upon a valid in-home eligibility assessment performed by a qualified registered nurse, as required by Medicaid policy. For example, during the relevant time period, Cook and her co-conspirators, which included PCS aides and Medicaid recipients, participated in a “fee-splitting” scheme. The scheme involved billing Medicaid for patient care services that were not rendered and then splitting the fraudulently obtained Medicaid reimbursements among the co-conspirators. As a result of the fee-splitting scheme, Cook received over $150,000 as payment to the fraudulent claims.
In addition to the fee-splitting scheme, Cook also submitted fraudulent claims to Medicaid for patient care services allegedly provided to Medicaid recipients, even though the services were not approved by a physician. Cook copied, altered and falsified physician signatures on forms in order to justify the fraudulent billing. In some instances, Cook altered the forms approving PCS for a Medicaid recipient, despite a physician’s clear denial of such services. Similarly, Cook and her co-conspirators submitted fraudulent claims for PCS based upon false and fraudulent nurse assessments, by forging nurses’ signatures on PCS assessment forms.
Justice.gov press release link: here