US attorneys: Medicaid scheme involved Dunn business

Greensboro woman sentenced in case

For the Record
Posted 5/25/22

The scheme reportedly involved a business operating at times in Dunn and Sanford.

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US attorneys: Medicaid scheme involved Dunn business

Greensboro woman sentenced in case

Posted

RALEIGH — A Greensboro woman, Sharita Mathis Richardson, was sentenced Wednesday to one year and 10 months in prison and three years of supervised release for conspiracy to commit health care fraud. The scheme reportedly siphoned $4 million from the state’s Medicaid system to cover false and fraudulent claims and involved a business operating at times in Dunn and Sanford.

Richardson pleaded guilty to the charge on March 25, 2021. She was also ordered to pay $2,005,531 in criminal restitution to the North Carolina Fund for Medical Assistance as part of her sentence.

“This defendant conspired with others to steal millions in federal funding intended to provide health care to those in need,” said U.S. Attorney Michael Easley. “Our office will continue to bring those who abuse and misuse taxpayer funds to justice.”

According to court documents and other information presented in court, between approximately 2012 and 2016, Richardson conspired with Antonio Fozard and others to defraud the North Carolina Medicaid system through the submission of over $4 million in false and fraudulent claims for the reimbursement of behavioral health services.

Medicaid is a federally funded health care benefit program that helps pay for medical-related services for low-income individuals and their families. In North Carolina, Medicaid is administered by the North Carolina Department of Health and Human Services, Division of Health Benefits.

Fozard owned and operated a number of behavioral health companies that purported to provide services to Medicaid beneficiaries in the Middle and Eastern Districts of North Carolina, according to a release from Easley’s office. These companies included Group Service Inc., and Zoofari Kids LLC, each of which “engaged in a systematic effort to steal from Medicaid by billing for services that were never rendered.”

Group Service maintained offices at various times in Raleigh, Dunn, Durham and Sanford. Among other things, Group Service employed Reginald Van Reese Jr. and Ruben Samuel Matos to canvas low-income neighborhoods to identify eligible Medicaid recipients and collect their personal identifying information (PII), including their Medicaid Identification numbers, according to the release.

“The harvested PII was then incorporated into false and fraudulent claims that Group Service submitted to Medicaid for reimbursement. Note writers, including Humberto Mercado, were also enlisted to fabricate supporting documentation in the event of a Medicaid audit. Richardson held herself out as Group Service’s chief operating officer and assisted Fozard in the day-to-day operations of the criminal enterprise,” the release stated.

“During much of the same time period, Fozard and Richardson were also managing members of Zoofari Kids, which was similarly defrauding the North Carolina Medicaid system. Zoofari Kids operated in Durham and Garner. The Durham location shared the same address as Group Service and purported to provide mental health treatment to Medicaid recipients. The Garner location was strictly a drop-in daycare facility. The daycare, however, was effectively funded by Medicaid fraud proceeds paid out to Zoofari’s mental health business.”

Fozard, Reese, Matos and Mercado each pleaded guilty to conspiracy to commit health care fraud in separate related cases. Reese, Matos and Mercado were previously sentenced to terms of imprisonment and ordered to pay restitution to the North Carolina Fund for Medical Assistance.

Fozard is scheduled to be sentenced during the term of court that begins on July 20.

United States District Judge Louise W. Flanagan sentenced Richardson. The Federal Bureau of Investigation and the Medicaid Investigations Division of the North Carolina Department of Justice investigated the case.  Assistant United States Attorney Adam F. Hulbig prosecuted the case for the government.

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