CHARLOTTE, N.C. – 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).
On March 27, 2012, a criminal bill of information charged Betty Ann Cook, 54, of Sparta, N.C., with one count of health care fraud conspiracy and one count of money laundering conspiracy. According to filed documents and statements made in court, Cook was the owner of Families First Home Health Care, a home health care company located in Alleghany Co., N.C. Cook’s company was enrolled with Medicaid to provide personal care services (“PCS”) such as bathing, dressing, and eating to Medicaid recipients. These types of services are provided by a home health aide in the recipient’s home.
According to filed documents and court proceedings, 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.
In her plea agreement, Cook admitted that as a result of her criminal conduct, the loss amount to Medicaid was between $200,000 to 400,000. The health care fraud conspiracy charge carries a statutory maximum of 10 years in prison and a fine of $250,000. The money laundering conspiracy charge carries a maximum of 20 years in prison and a $500,000 fine or twice the value of the money laundered. Cook has agreed to pay full restitution for her criminal conduct. The restitution amount will be determined by the Court at a later date.
A separate federal criminal bill of information filed in February 2012, charged Cook’s co-conspirator, Crystal Deleon Evans, 33, of Sparta, with one count of health care fraud conspiracy. Evans pled guilty to the charge in March 2012. According to the charging document, from 2007 through 2010, Evans worked as a home health aide for Cook’s home health care company and participated in Cook’s fee-splitting scheme. As part of the scheme, Cook paid Evans to sign blank timesheets. Cook then filled out the timesheets claiming that Evans had provided home health aide services to Medicaid recipients and submitted those timesheets to Medicaid for reimbursement, when, in fact, Evans had never provided such services to the recipients. Evans admitted that Medicaid’s loss as a result of her conduct ranges between $30,000 and $70,000 and has agreed to full pay restitution. Evans faces a maximum sentence of 10 years in prison and a $250,000 fine.
Both Cook and Evans remain free on bond. A sentencing date for the defendants has not been set yet.
In addition to the federal charges, nine other individuals pled guilty in the Allegheny County District Court to misdemeanor charges of conspiracy to commit Medicaid fraud. Those individuals, listed below, all were sentenced to probationary terms.
• Jessica Beth Absher-Shelton, 33, of Anderson, S.C.
• Patricia Atkins, 62, of Low Gap, N.C.
• Billie Jo Bingman, 34, of Sparta, N.C.
• Crystal Brewster, 34, of Sparta, N.C.
• Lisa Marie Cook, 35, of Sparta, N.C.
• Rena Mahan, 32, of Sparta, N.C.
• Desiree Payne, 22, of Sparta, N.C.
• Dwana Sanchez, 36, of Sparta, N.C.
• Tammy Williams, 43, of Laurel Springs, N.C.
The nine pleas to state charges were part of statewide sweep conducted by the N.C. Attorney General’s Medicaid Investigations Unit that resulted in 18 arrests in December 2011.
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