Durham Resident Sentenced for Conspiracy Targeting North Carolina Medicaid
NEW BERN – United States Attorney Robert J. Higdon, Jr. announced that today in federal court, United States District Judge Louise W. Flanagan sentenced TAMARA PERRY MCCAFFITY, 57, of Durham, North Carolina to 46 months imprisonment, followed by 3 years of supervised release. MCCAFFITY was also ordered to forfeit various real estate properties and to pay restitution in the amount of $523,783.00 to North Carolina Medicaid, among other terms of the judgment.
MCCAFFITY was named in a Criminal Information filed on July 17, 2018 which charged her with conspiracy to commit health care fraud. On October 19, 2018, MCCAFFITY pled guilty to the charge.
According to the charging instrument, statements made in open court, and other public information, MCCAFFITY operated two mental health businesses in North Carolina (Dreamworks II and Prominence Consulting & Therapeutic Services) that were used to submit over $900,000 in fraudulent billings to Medicaid over a three-year period. As part of the conspiracy, the billings submitted by MCCAFFITY’s companies claimed reimbursement for mental health services that were never rendered. For example, the Dreamworks II submissions included claims in which the rendering clinician supposedly conducted one-hour counseling sessions for more than 24 clients in a single day. Both Dreamworks II and Prominence Consulting also used stolen Medicaid beneficiary information and/or clinician information. Prominence Consulting, for instance, was a shell company registered to an empty office suite in Raleigh, but it submitted thousands of false claims seeking reimbursement for services purportedly rendered on behalf of Medicaid beneficiaries. In truth, no services were ever provided by Prominence, and the Medicaid beneficiary and clinician information listed on the claims was fraudulently obtained and used in furtherance of the scheme.
Mr. Higdon commented: “The defendant engaged in an elaborate scheme to defraud the taxpayers of this country and we are very pleased with the sentence the court imposed. Prorection of government programs designed to help the most vulnaerable among us is a key priority of this office and of the United States Justice Department.”
“When people defraud the Medicaid program, they’re cheating taxpayers and taking away resources from people who need healthcare,” said Attorney General Josh Stein. “My office will continue to hold people responsible for these fraudulent practices.”
MCCAFFITY’s co-conspirators included Christopher Leon Brown, who was previously convicted and sentenced by the Court to 40 months in prison.
Investigation of this case was conducted by the Federal Burean of Investigation (FBI) and the North Carolina Department of Justice, Medicaid Investigations Division. Assistant United States Attorney Adam F. Hulbig represented the government.