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Description: Raleigh, North Carolina criminal law lawyer represented Defendant charged with conspiracy to defraud the North Carolina Medicaid system.
Between approximately 2012 and 2017, Antonio Deon Fozard was a leader in a multi-district conspiracy to defraud the North Carolina Medicaid system through the submission of more than $7 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 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, including Group Service, Group Service Solution, Zoofari Kids, and In Touch of Care. Each of these entities 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 co-conspirators 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. The harvested PII was then incorporated into false and fraudulent claims that Group Service submitted to Medicaid for reimbursement. Various “note writers,” including co-conspirator Humberto “Ghost” Mercado, were enlisted to fabricate supporting documentation in the event of a Medicaid audit. At one point during the conspiracy, Group Service was audited by a Medicaid contractor. To obstruct the audit, Fozard directed note writers to fabricate medical records and then caused those records to be provided to investigators.
During much of the same time period, Fozard and another co-conspirator, Sharita Mathis Richardson, were operating Zoofari Kids, which was similarly defrauding North Carolina Medicaid. Zoofari 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. Under Fozard’s leadership, Zoofari filed thousands of false claims in the name of a rendering provider whose information was used without his knowledge or consent, obtained lists of stolen Medicaid beneficiary information for incorporation into the fraudulent billings, and created fake medical records.
After Group Service was barred from billing Medicaid, Fozard engaged in another billing scheme through a different business, In Touch of Care. According to the investigation, In Touch of Care recycled Medicaid information from fraudulent billings submitted by prior Fozard-controlled entities. Additionally, Fozard caused In Touch of Care to bill for services using the clinician information for a nurse practitioner who never performed the listed services.
In addition to engaging in health care fraud through businesses under his direct control, Fozard collaborated with third party owners and operators of other purported behavioral health companies for the purpose of cheating the Medicaid system. For example, Fozard conspired with brothers Jerry and Tony Taylor, the owners of Taylor Behavioral Health and Options Driven in Monroe, North Carolina, by selling them lists of stolen Medicaid beneficiary information for use in their own fraudulent billings.
Reginald Van Reese, Jr., Ruben Samuel Matos, Humbert Mercado, and Sharita Mathis Richardson, each pleaded guilty to health care fraud charges and were sentenced to prison in related cases filed in the Eastern District of North Carolina. Co-conspirators Jerry and Tony Taylor pleaded guilty to heath care fraud charges and were sentenced to prison in related cases filed by the United States Attorney’s Office for the Western District of North Carolina.
Michael Easley, United States Attorney for the Eastern District of North Carolina, made the announcement after sentencing by United States District Judge Louise W. Flanagan. The Federal Bureau of Investigation and the North Carolina Medicaid Investigations Division investigated the case. Assistant United States Attorney Adam F. Hulbig prosecuted the case for the government.
Health Care Fraud Conspiracy
Health Care Fraud
Outcome: Count 1 - 120 months imprisonment - Count 2 - 31 months imprisonment, to be served consecutively to produce a total term of 151 months - 3 years of supervised on each Count to run concurrently - $200 special assessment and restitution in the amount of $4,242,794.00