Charlotte Woman Pleads Guilty to Conspiracy to Defraud Medicaid of More Than $4.3 Million
CHARLOTTE, NC—A Charlotte woman appeared in federal court today and admitted to conspiring to defraud Medicaid of at least $4.3 million, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina. Aliya Boss, 35, of Charlotte, pleaded guilty before U.S. Magistrate Judge David C. Keesler to one count of health care fraud conspiracy.
In a separate case, Zaria Davis Humphries pleaded guilty on Tuesday, November 24, 2014, to one count of health care fraud conspiracy for attempting to steal over $850,000 from Medicaid.
In a still further separate case, charging documents and plea agreements have been filed against two women also facing health care fraud conspiracy charges. Sakeenah David Davis and Kino Legette Williams are expected to enter formal guilty pleas on Thursday, December 4, 2014, for conspiring to defraud Medicaid of at least $1.6 million.
U.S. Attorney Tompkins is joined in making today’s announcement by Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Division (MID), and John A. Strong, Special Agent in Charge of the Federal Bureau of Investigation (FBI), Charlotte Division.
Aliya Boss According to filed documents and today’s plea hearing, from 2012 to June 2013, Boss participated in a scheme to defraud Medicaid of at least $4.3 million by submitting false reimbursement claims for mental and behavioral health services that she did not provide. Filed court documents indicate that Boss, a licensed social worker, is approved by Medicaid to bill for and receive reimbursement for therapy services provided to Medicaid recipients.
According to court documents, Boss conspired with others and agreed to allow at least two mental health companies to submit fraudulent reimbursement claims to Medicaid using her provider number for sham mental and behavioral health services that Boss never provided. Court documents indicate that, in some instances, the fraudulent reimbursement claims submitted to Medicaid claimed that Boss had provided as many as 140 hours of therapy during a single 24-hour day. In exchange for lending her Medicaid provider number Boss received monthly payments from the companies, even though she knew she never provided those services.
In addition to “renting out” her provider number, court documents indicate that, at the assistance of one conspirator, Boss submitted false claims to Medicaid for fraudulent counseling services through her own company, “Boss Counseling and Consulting, LLC.” According to court records, Boss billed Medicaid for fraudulent therapy services using the Medicaid numbers of beneficiaries collected by another member of the conspiracy working as a “patient recruiter.”
Court records indicate that the patient recruiter collected the Medicaid numbers from the recipients in exchange for cash or indirectly by paying for food and taxi rides, among other things.
According to court records, the conspirators then used the beneficiaries’ numbers to file the fraudulent reimbursements, claiming, in some instances, that Boss provided therapy services to more than 200 Medicaid recipients in a single day and billing for more than 64 hours of therapy over the course of a 24-hour period. In all, court records show that Boss and her conspirators caused Medicaid pay out over $1,135,302.27 as a result of the false claims, of which $306,965.56 was paid out directly to Boss.
Boss was released on bond following her guilty plea. The maximum prison term for the health care fraud conspiracy charge is 10 years and a $250,000 fine. Boss has also agreed to pay restitution, the amount of which will be determined by the Court at sentencing, which has not been set yet.
In a separate case, on Tuesday, November 24, 2014, Zaria Davis Humphries pleaded guilty to one count of health care fraud conspiracy. Humphries, 41, of Charlotte, admitted before Judge Keesler that she participated in a similar health care fraud scheme that attempted to defraud Medicaid of over $850,000 by submitting false claims for mental and behavioral health services that were never provided. Of the claims submitted, court records indicate that Medicaid paid out a total of $222,037 directly to Humphries. Court records in this case indicate that Humphries is a licensed social worker and the owner and operator of “Life Impact Solutions, LLC” (Life Impact), a company specializing in behavioral and counseling services. Court records show that from January to June 2013, Humphries and her conspirators submitted fraudulent claims to Medicaid for non-existent services, using Humphries’ Medicaid provider number. According to court records, at the assistance of one conspirator, Humphries filed the fraudulent claims using the Medicaid number of beneficiaries collected by a patient recruiter. As part of her plea agreement, Humphries admitted that, in some instances, she claimed she personally provided more than 39 hours of therapy in a 24-hour period and that she provided therapy to more than 100 Medicaid recipients in one day. Humphries was also released on bond and is awaiting sentencing. She faces a maximum prison term of 10 years and a $250,000 fine.
Two more women face health care fraud conspiracy charges in connection with a scheme that attempted to defraud Medicaid of at least $1.6 million. Filed court documents indicate that that Sakeenah David Davis, 37, and Kino Legette Williams, 36, both of Charlotte, each have agreed to plead guilty to one count of heath care fraud conspiracy for filing fraudulent reimbursement claims with Medicaid for outpatient behavioral services that were never provided.
Court documents show that the two women owned and operated “New Choices Youth and Family Services,” (New Choices), a Medicaid-approved company that purportedly provided outpatient mental and behavioral therapy services. According to court records, from October 2012 to July 2013, Davis and Williams hired a conspirator as the director of New Choices and agreed to pay her $4,000 per month for her services. Court records show that the director-conspirator billed Medicaid for fraudulent services never provided by New Choices.
Court records show that all the claims submitted to Medicaid from New Choices listed “S.B.” as the attending clinician, even though S.B. did not provide the claimed services. In some instances, according to court records, New Choices’ billing claimed that the hours of therapy S.B. had provided over the course of a single day far exceeded a 24-hour period, in one instance claiming more than 77 hours of therapy in one day. Court records also show that the conspirators used the Medicaid numbers of beneficiaries collected by a patient recruiter and fabricated patient notes to cover up the fraud. According to court records, the defendants were aware of the scheme but did not inquire about or attempt to stop the fraud. Instead, according to court records, they used some of the stolen funds to pay for personal expenses, including jewelry and to pay for Davis’s wedding. Davis and Williams admitted that fraudulent reimbursement claims totaling $1,696,225 were submitted to Medicaid over the course of the scheme, of which $506,124 was paid out to Williams and Davis.
The defendants are expected to appear in court on Thursday, December 4, 2014, before U.S. Magistrate Judge David S. Cayer to formally accept their guilty pleas. The health care fraud conspiracy charge carries a maximum prison term of 10 years and a $250,000 fine.
The FBI conducted the investigations with the assistance of MID. The prosecution of the cases is handled by Assistant U.S. Attorney Kelli Ferry of the U.S. Attorney’s Charlotte Office.
The investigation and charges are the work of the Western District’s joint Health Care Fraud Task Force. The Task Force is multi-agency team of experienced federal and state investigators, working in conjunction with criminal and civil Assistant United States Attorneys, dedicated to identifying and prosecuting those who defraud the health care system, and reducing the potential for health care fraud in the future. The Task Force focuses on the coordination of cases, information sharing, identification of trends in health care fraud throughout the region, staffing of all whistle blower complaints, and the creation of investigative teams so that individual agencies may focus their unique areas of expertise on investigations. The Task Force builds upon existing partnerships between the agencies and its work reflects a heightened effort to reduce fraud and recover taxpayer dollars.
If you suspect Medicare or Medicaid fraud please report it by phone at 1-800-447-8477 (1-800-HHS-TIPS), or E-Mail at HHSTips@oig.hhs.gov.