Gastonia Woman Sentenced To 15 Months In Prison For Scheme To Defraud Medicaid

Defendant Ordered to Pay $2.7 million in Restitution

CHARLOTTE, N.C. – A Gaston County woman was sentenced on Wednesday, October 31, 2012, to serve 15 months in prison, to be followed by three years of supervised release for her role in a scheme to defraud North Carolina Medicaid, announced the U.S. Attorney’s Office for the Western District of North Carolina.

Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Division (MID), Derrick Jackson, Special Agent in Charge, Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region and Chris Briese, Special Agent in Charge of the Federal Bureau of Investigation (FBI), Charlotte Division, join the U.S. Attorney’s Office in making today’s announcement.

Joanna Patronis, 41, of Gastonia, N.C. pleaded guilty in April 2011, to one count of conspiring to commit health care fraud. According to court documents and court proceedings, Patronis and others engaged in a scheme to defraud Medicaid by submitting fraudulent claims for mental and behavioral health services which falsely listed Medicaid-approved providers as the attending clinicians when those providers, in fact, did not provide the claimed services. Filed court documents show that in or about December 2009, Patronis created the company A Time for Everything (“ATE”) for the sole purpose of allowing non-approved Medicaid providers to submit claims to Medicaid. Patronis falsely stated to Medicaid that Dr. L.D., a licensed psychologist, was associated with ATE and then submitted fraudulent claims to Medicaid indicating that Dr. L.D. had provided services to ATE clients. Dr. L.D. did not provide any of the claimed services.

According to court documents and court proceedings, Patronis also engaged in a similar scheme to submit false claims to Medicaid through a second company, Hope and Family Behavioral Resources (“HFBR”). Co-conspirator Giraud Hope, the owner of HFBR, agreed to submit claims through HFBR’s Medicaid provider number which falsely listed Dr. L.D. as the attending clinician. Patronis acted as the medical biller for these false claims and introduced co-conspirators to Hope for the purpose of submitting false claims through HFBR’s provider number.

U.S. District Court Judge Max O. Cogburn, Jr. also ordered Patronis to pay $2,742,337 in restitution and to forfeit $46,857.57 in funds seized during the course of the investigation, a 2010 Toyota Rav-4, and her residence located in Cramerton.

Judge Cogburn sentenced Giraud Hope in October 2011 to 15 months in prison for conspiring to commit health care fraud.

The investigation was led by the HHS-OIG and MID, with assistance from the FBI. The prosecution is handled by Assistant U.S. Attorney Kelli Ferry of the U.S. Attorney’s Charlotte Office.

Patronis has been released on bond since entering her guilty plea. She will be ordered to report to a federal facility, at which time she will be transferred into custody of the Federal Bureau of Prisons. Federal sentences are served without the possibility of parole.

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.