Angier, NC Resident Sentenced for Conspiring to Defraud the North Carolina Medicaid System
NEW BERN, N.C. – An Angier, North Carolina man, Ruben Samuel Matos, was sentenced today to 42 months in prison and three years of supervised release for conspiracy to commit health care fraud. On September 18, 2020, Matos pled guilty to the charge. As part of sentencing, Matos was also ordered to pay $1,997,883 in criminal restitution to the North Carolina Fund for Medical Assistance.
According to court documents and other information presented in court, between 2014 and 2017, Matos conspired with multiple individuals and businesses to defraud the North Carolina Medicaid system by submitting over $3.6 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-related 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.
Matos initially partnered with Reginald Van Reese, Jr., a Raleigh, NC resident who was previously convicted of conspiracy in a related case. As part of the scheme, Matos and Reese canvassed low-income neighborhoods to identify eligible Medicaid recipients and collect their personal information, including Medicaid identification numbers. The beneficiary information was then sold and supplied to behavioral health business operators for the unlawful purpose of generating fraudulent claims for reimbursement of services that were never rendered.
Matos and Reese worked closely with co-conspirator Antonio Deon Fozard, a Durham, NC resident who controlled multiple behavioral health entities, including Group Service and In Touch of Care. Fozard, Matos, and Reese defrauded the North Carolina Medicaid system by incorporating stolen Medicaid beneficiary and clinician data into false billings for these entities and enlisting “note writers” to fabricate supporting medical documentation for use in the event of an audit.
In furtherance of a similar Medicaid fraud scheme, Matos and Reese later partnered with Luis Angel Lozada, a Clayton, NC resident who owned and operated Cornerstone Family Services Group, a purported behavioral health business in Zebulon, NC. According to the investigation, Cornerstone used stolen Medicaid beneficiary and clinician data to back-bill the Medicaid system and recruited note writers to prepare bogus medical records to substantiate the claims.
Antonio Fozard and Luis Lozada pleaded guilty to health care fraud charges in the U.S. District Court for the Eastern District of North Carolina and are currently awaiting sentencing.
G. Norman Acker, III, Acting U.S. Attorney for the Eastern District of North Carolina made the announcement after sentencing by U.S. District Judge Louise W. Flanagan. The Federal Bureau of Investigation and the North Carolina Medicaid Investigations Division investigated the case. Assistant U.S. Attorney Adam F. Hulbig prosecuted the case for the government.
Related court documents and information can be found on the website of the U.S. District Court for the Eastern District of North Carolina or on PACER by searching for Case No. 5:20-CR-307.