RALEIGH — Multiple cases involving North Carolina residents and companies are a part of the recently announced $14.6 billion health care fraud takedown by the U.S. Department of Justice on June 30.
“This record-setting Health Care Fraud Takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers,” Attorney General Pamela Bondi said in a press release. “Make no mistake — this administration will not tolerate criminals who line their pockets with taxpayer dollars while endangering the health and safety of our communities.”
Officials described the operation as the largest takedown involving health care fraud schemes in U.S. Department of Justice (DOJ) history.
Through “Operation Goldrush,” federal authorities used data analytics to identify and charge 29 individuals involved with “transnational criminal organizations” with schemes totaling $12 billion in fraudulent claims, including a $10.6 billion scheme involving stolen identities for fake Medicare claims. Those charges are from multiple Eastern European countries, Pakistan, Russia and the United Arab Emirates.
More than 320 people are being charged as part of the sweep, and over $245 million in cash, cryptocurrency and property of various types have been seized.
According to the case summaries provided by the USDOJ, a number of those charged reside or run businesses in North Carolina.
According to the summaries, a case being prosecuted in the Eastern District of North Carolina involves three individuals: Kimberly Mable Sims, Francine Sims Super and Keke Komeko Johnson.
The trio is being charged in connection with “the payment of more than $1 million in illegal remunerations in the form of gift cards to patients of Life Touch,” which is a substance abuse treatment company in the state. They are also being charged with making false statements to medical auditors regarding the payment, as well as Life Touch staff receiving “kickbacks from a lab company that it utilized for drug testing services.”
Another case being handled by the Eastern District of North Carolina involves an individual residing in Florida.
Randal Fenton Wood of Flagler Beach, Florida, has been charged with “conspiracy to commit health care fraud in connection with a scheme to bill Medicare, the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), and other insurance programs for medically unnecessary durable medical equipment (“DME”).”
Wood owned Greenleaf Medical Supply and Nevaeh & Company (operating as Restorative Medical), which were based near Winston-Salem. Both entities operated as DME supply companies, which submitted claims to Medicare for DME supplied to beneficiaries.
According to court filings, Wood conspired with seven other entities in North Carolina to defraud Medicaid, including Dox Depot, Tri-Cities, QSH, London Medical Supply, Harp Medical Supply and Advanced Rehab Technologies. The latter three were all owned by one individual dubbed “J.F.” in the filing.
Another entity Wood engaged with for the same purposes was ”M.R., the owner of Magnolia Healthcare (operating as Therapeutic Healthcare) and Bluewater Healthcare. Magnolia and Bluewater were limited liability companies incorporated in Louisiana that operated as DME supply companies.
The DOJ said the scheme resulted in more than $39 million in Medicare reimbursements, with Wood personally linked to at least $9.141 million in forfeitable proceeds.
In the Western District of North Carolina, Crystal Sherrell Jackson of Charlotte was charged with health care fraud and money laundering tied to fraudulent claims for drug testing and psychotherapy submitted to North Carolina’s Medicaid system.
According to the filings, Jackson was a licensed clinical addiction specialist when she committed the offenses. She owned a state Medicaid provider outfit called Jackson Consulting Services.
“Jackson used her company to submit $1.9 million of false and fraudulent claims in the names of North Carolina Medicaid beneficiaries for drug tests that were not performed or were medically unnecessary, of which $1.6 million were paid,” the USDOJ press release said.
Another case being prosecuted in the Western District of North Carolina involves at least seven people, three of whom are cited as residing in North Carolina.
Individuals named in the filings and press release as residing in North Carolina include Donald Calvin Saunders (Charlotte), Latarsa Hitchcock (Raleigh) and Dajuan Strickland (Charlotte).
They have been charged with conspiring to defraud the South Carolina Medicaid Program (SC Medicaid) and engaging in illegal kickbacks and money laundering.
According to the case filings, the defendants allegedly submitted fraudulent claims for behavioral health services that were not provided through illegally obtained Medicaid beneficiary personal identifiable information and National Provider Identification numbers. They are also accused of operating multiple billing provider companies to submit false claims, resulting in more than $2.7 million in fraudulent payments from SC Medicaid.
A fourth individual, David Cory Hill, of Charlotte, was charged separately with conspiracy to defraud the United States government and money laundering.
The individual case filings can be accessed through the DOJ website.
