Russ Ferguson, U.S. attorney for the Western District of North Carolina, joined North and South Carolina’s attorneys general and other officials on Monday in Charlotte to announce the results of a major health care fraud crackdown.
The investigation led to charges against nine people accused of defrauding Medicaid programs in both North and South Carolina, who are accused of stealing a total of around $23 million, much of it using fraudulent billing and stolen personal identifying information.
N.C. Attorney General Jeff Jackson said that the crackdown was made possible by new software tools that help investigators spot fraud more easily.
“We now have software that allows us to do all kinds of regression analysis to make fraud easier to spot," Jackson said. "Some of these folks are very sophisticated in ways that they layer their fraud. It’s getting very difficult to hide it.”
Charlotte resident Crystal Jackson is facing charges of health care fraud and money laundering. Prosecutors allege she submitted fraudulent claims to North Carolina’s Medicaid program for $1.9 million worth of psychotherapy services and urine drug tests. Jackson ran Jackson Consulting Services, which was licensed as a mental health agency and clinical lab.
The other eight individuals were charged in the Western District of North Carolina for defrauding South Carolina's Medicaid out of $21 million. Donald Saunders, the alleged leader of that scheme, faces six counts of health care fraud and three counts of money laundering.
The others face various charges, including conspiracy to commit health care fraud and receive or pay illegal kickbacks.
David Corey Hill, of Concord, was separately charged with conspiracy to commit health care fraud and money laundering. Hill has agreed to plead guilty.
After announcing the charges, South Carolina Attorney General Alan Wilson gave a warning.
“For those out there who are conducting these types of alleged conduct, we will find you and we will get you,” Wilson said.
This operation is part of the Justice Department’s nationwide effort to combat health care fraud.
James Barnacle, the acting special agent in charge of the FBI in North Carolina, said that nationwide there have been common patterns with fraudulent billing.
“What we see across the country is fraudulent billing to healthcare programs," Barnacle said. "We see treatment that is medically unnecessary for people, and we also see a lot of drug diversion.”
The Justice Department’ said so far it has charged 324 people nationwide for their connection to more than $14.6 billion in alleged fraud.
