A Cast of Unscrupulous Characters

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Confident Doctor shaking hands with patients talk in the hospital

As today’s fraud drama unveils, we see a cast of unscrupulous characters that include two brothers, an office billing manager, a licensed nurse practitioner, and an individual who is an expert at forging medical treatment notes (I didn’t know that was a “thing”.) The opening scene takes place in a North Carolina office where behavioral health services are offered. Can you guess what the drama is about? (Spoiler alert: it involves millions of dollars in Medicaid fraud and tax fraud.) While this is not an action film, you could say that the unscrupulous characters involved took plenty of illegal action to carry out their Medicaid fraud scheme.

Today’s drama does not disappoint when it comes to the typical struggle between the bad guys and the good guys. Two brothers (one from Charlotte and the other from Atlanta) put their heads together and came up with a Medicaid fraud scheme that involved submitting fake reimbursement claims to North Carolina’s Medicaid program. They falsified paperwork that claimed behavioral services were provided to at-risk youth in North Carolina. (As you might guess, those services were not provided, but Medicaid paid out $6.1 million as if they were.)

 Here’s how the bad guys carried out their Medicaid fraud scheme: the two brothers owned and operated multiple entities that purportedly provided behavioral health services in Monroe, Raleigh and Gastonia. The ringleader of the scam recruited co-conspirators and also obtained prospective lists with personal information such as Medicaid beneficiary subscriber numbers.

The nurse practitioner falsified patient records while another employee prepared fake treatment notes and billing spreadsheets for the companies owned and operated by the brothers. The brothers and the billing manager submitted fraudulent claims to Medicaid, using the illegally obtained personally identifiable information.

The plot thickens. The ringleader not only defrauded Medicaid of $6.1 million, he also failed to submit his tax returns in a timely manner for three years. (While today’s fraud drama was not a musical, the two brothers were singing all the way to the bank where they deposited more than $4.1 million received as a result of the fraudulent Medicaid claims.) As if that were not enough, the ringleader also diverted the fraudulent Medicaid receipts to other individuals in on the scheme and used the Medicaid funds for personal expenditures. (Shopping spree!)

The 39-year-old ringleader pleaded guilty to healthcare fraud and tax fraud. His 54-year-old brother from Wingate pleaded guilty to the same charges. (It’s interesting that the younger brother was running the scam, while the older brother followed his lead. Older doesn’t always mean wiser.) Their 40-year-old office billing manager pleaded guilty to healthcare fraud; the licensed nurse practitioner pleaded guilty to money laundering and the 50-year-old individual, who forged medical treatment notes, is charged with healthcare fraud and awaits her trial.

Both brothers face a maximum of 10 years in prison and a $250,000 fine for the healthcare fraud charges. The tax evasion charge carries up to five years in prison and a $250,000 fine, or twice the actual gain. The other conspirators are either awaiting trial or sentencing.

So, for a quick recap: the good guys were the Western District’s joint Health Care Fraud Task Force. The multi-agency team of experienced federal and state investigators worked with criminal and civil Assistant U.S. Attorneys to catch the bad guys who were trying to pull the wool over the eyes of the Medicaid program and the Internal Revenue Service. (As the scene fades to black, you can almost hear the metal clink of the jail doors closing on another successful prosecution of a cast of unscrupulous characters.)

Today’s “Fraud of the Day” is based on a Department of Justice press release, “Leader of $6.1 Million Medicaid Fraud Scheme Pleads Guilty To Federal Charges,” released on October 31, 2019.

CHARLOTTE, N.C. – Tony Garrett Taylor, 39, formerly of Charlotte, N.C. and currently residing in Atlanta, Georgia, pleaded guilty today to health care fraud conspiracy and tax evasion, for his role in a scheme that defrauded the North Carolina Medicaid (Medicaid) of more than $6.1 million, announced Andrew Murray, U.S. Attorney for the Western District of North Carolina.  U.S. Magistrate Judge David S. Cayer presided over the plea hearing.

North Carolina Attorney General Josh Stein, who oversees the North Carolina Medicaid Investigations Division (MID), joins U.S. Attorney Murray in making today’s announcement.

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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.