Three Sentenced for Stealing Millions from Medicaid
CHARLOTTE, NC—Three Charlotte women were sentenced today for conspiring to steal millions from Medicaid, announced Jill Westmoreland Rose, Acting U.S. Attorney for the Western District of North Carolina. All three defendants appeared before Chief U.S. District Judge Frank D. Whitney and were sentenced as follows: Aliya Boss, 36, of Charlotte, was sentenced to 44 months in prison, followed by three years of supervised release and was ordered to pay $1,135,302.27 as restitution to Medicaid; Sakeenah David Davis, 38, of Charlotte, was sentenced to 42 months in prison, three years of supervised release and was ordered to pay restitution in the amount of $506,124; and Kino Legette Williams, 37, of Charlotte, was handed down a 35-month sentence, was ordered to serve three years under court supervision and to pay $506,124 as restitution to Medicaid.
Acting U.S. Attorney Jill Westmoreland Rose is joined by John A. Strong, Special Agent in Charge of the Federal Bureau of Investigation (FBI), Charlotte Division.
According to filed court documents in each case and today’s sentencing hearings:
From 2012 to June 2013, Boss was involved in a scheme to defraud Medicaid of more than $4.3 million by submitting false reimbursement claims for mental and behavioral health services that she did not provide. Boss, a licensed social worker and owner of “Boss Counseling and Consulting, LLC.,” was approved by Medicaid to bill for and receive reimbursement for therapy services provided to Medicaid recipients. 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, Boss also submitted false claims to Medicaid for fraudulent counseling services through her own company, using the Medicaid numbers of beneficiaries collected by another member of the conspiracy working as a “patient recruiter.”
Boss and her conspirators filed fraudulent claims, in some instances claiming that therapy services were provided to more than 200 Medicaid recipients in a single day or billing for more than 64 hours of therapy over the course of a 24-hour period. Of the fraudulent claims filed, $306,965.56 of the reimbursement funds was paid out directly to Boss.
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From October 2012 to July 2013, Sakeenah Davis and Kino Williams were involved in a scheme to defraud Medicaid of more than $1.6 million by submitting fraudulent reimbursement claims for mental and behavioral health services that were not provided. Davis and Williams owned and operated “New Choices Youth and Family Services,” (New Choices), a Medicaid-approved company that purportedly provided outpatient mental and behavioral therapy services. During the relevant time period, Davis, Williams and others 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 that never provided by New Choices. Court records show that all the fraudulent claims listed “S.B.” as the attending clinician, even though S.B. did not provide the claimed services. In some instances, 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. As a result of the fraudulent claims, over the course of the conspiracy Medicaid paid out $506,124 to Williams and Davis. The two women used some of the stolen funds to pay for personal expenses, including jewelry and to pay for Davis’s wedding.
All three defendants previously pleaded guilty to one count of health care fraud conspiracy. They will be ordered to report to the Federal Bureau of Prisons upon designation of a federal facility. All federal sentences are served without the possibility of parole.
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.