United States Attorney Anne M. Tompkins
Western District of North Carolina
OWNER OF CHARLOTTE HEALTH CARE COMPANY SENTENCED TO PRISON FOR $1.9 MILLION MEDICAID FRAUD CHARLOTTE, N.C. – The owner of a Charlotte mental and behavioral health services company was sentenced on Tuesday, October 18, 2011, to serve 15 months in federal prison, to be followed by three years of supervised release for his role in a Medicaid fraud scheme, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina.
U.S. Attorney Tompkins is joined in making today’s announcement by Attorney General Roy Cooper, who overseas the North Carolina Medicaid Investigations Unit (MIU); 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 Russell F. Nelson, Special Agent in Charge of the United States Secret Service (USSS), Charlotte Field Division.
Giraud Hope, 49, of Charlotte, entered a plea of guilty on February 9, 2011, to one count of conspiring to commit health care fraud. According to court documents and court proceedings, Hope, through his mental and behavioral health services company, Hope and Family Behavioral Resources (HFBR), engaged in a scheme to defraud the North Carolina Medical Assistance Program (Medicaid). From in or about August 2009, Hope hired a co-conspirator to act as a medical biller and submit claims on behalf of HFBR to Medicaid for reimbursement. Based on information contained in court documents, from in or about November 2009 to in or about October 2010, using HFBR’s Medicaid provider number, Hope and his co-conspirator submitted false and fraudulent claims to Medicaid for services allegedly provided by other unlicensed individuals who did not have authorization to submit claims to and receive payment from Medicaid. Hope and his co-conspirator listed “Dr. L.D.” as the rendering provider on all the fraudulent claims submitted through Hope’s company. As part of his plea, Hope admitted that neither Dr. L.D. nor Hope supervised the unlicensed individuals who submitted the claims for service through HFBR. Hope also admitted that
he never met some of the individuals who allegedly provided the services, and, in fact, Hope did not even know whether the individuals were actually licensed, or whether any of the claimed services were actually provided. Court documents indicate that in exchange for permitting these unauthorized individuals to submit claims to Medicaid for reimbursement through HFBR, Hope received a percentage of the reimbursement payments received from Medicaid for those fraudulent claims.
At the sentencing hearing, U.S. District Judge Max O. Cogburn, Jr. found that the fraud scheme resulted in a loss to Medicaid of $1,948,451.31 and ordered Hope to pay restitution in that amount. Hope has been released on bond since entering his guilty plea. He will be ordered to report to a federal facility, at which time he will be transferred into custody of the Federal Bureau of Prisons. Federal sentences are served without the possibility of parole.
The investigation into Hope was handled by HHS-OIG, MIU, and USSS. The prosecution was 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.