Medicaid Biller Sentenced to Prison for Medicaid Fraud

NEW BERN – United States Attorney Robert J. Higdon, Jr. announced that yesterday in federal court, United States District Judge Louise W. Flanagan sentenced RENEE CHRISTINE BORUNDA, 36, of Greensboro, North Carolina, to 37 months in federal prison followed by 3 years of supervised release following her prior guilty plea to Conspiracy to Commit Health Fraud Conspiracy and Aggravated Identity Theft.  BORUNDA was also ordered to make restitution of $225,399.08 to the North Carolina Medicaid program.

The Criminal Information to which BORUNDA pleaded guilty, as well as information provided at the sentencing hearing, stated that BORUNDA managed a company that offered behavioral health services to Medicaid recipients in Wilson, North Carolina.  In 2013 and 2014, BORUNDA used one of the company’s therapist’s personal information to submit fraudulent electronic claims.  The claims were submitted from two different companies.  The claims falsely represented that the therapist had provided $225,339.08 worth of behavioral services to over 200 different Medicaid recipients who lived in Beaufort, Edgecombe, Greene, Guilford, Lenoir, Mecklenburg, Pitt, and Wilson Counties, when in fact no such services were rendered.  The therapist was unaware that her information was being used to commit the fraud.   

United States Attorney Robert J. Higdon, Jr. stated, “Fraud in the behavioral health sector is a plague upon our district and the country at large.  This case, like several others prosecuted by this office in the last several years, sends a strong message to those who seek to defraud Medicaid and Medicare - programs essential to the wellbeing of the American people.  These individuals will be aggressively prosecuted.”

North Carolina Attorney General Josh Stein said, “Cheating Medicaid wastes tax dollars, and it’s unacceptable.  My office will continue our work to protect taxpayers and hold the healthcare providers who commit fraud accountable.”  

The investigation of this case was conducted by agents of the North Carolina State Bureau of Investigation (“SBI”) assigned to the Medicaid Investigations Division of the North Carolina Attorney General’s Office (“MID”), Financial Investigators with the MID, and the Internal Revenue Service - Criminal Investigation.  Assistance was provided by the Office of Compliance and Program Integrity of the North Carolina Division of Health Benefits, EastPointe, Sandhills Center, and Trillium Health Resources.       The investigation and prosecution of this matter was handled in a partnership between the United States Attorney’s Office for the Eastern District of North Carolina and the Medicaid Investigations Division of the North Carolina Attorney General’s Office.  SBI Assistant Special Agent in Charge Lolita Howell was the lead investigator.  Special Assistant United States Attorneys Mike Heavner and John Parris of the Medicaid Investigations Division of the North Carolina Attorney General’s Office represented the United States.