Lumberton Woman Sentenced For Health Care Fraud

New Bern - United States Attorney Thomas G. Walker announced that in federal court on January 31, 2013, United States District Judge Louise W. Flanagan sentenced ANDETRA MICHELLE SAMPSON, 39, to 60 months imprisonment followed by 3 years supervised release, for her involvement in a health care fraud scheme that defrauded Medicaid of at least $2,187,951.65 for false billings for behavioral health services for children that were not provided. Sampson was ordered to pay full restitution to Medicaid in the amount of the fraud.

On July 11, 2012, SAMPSON pled guilty to one count of conspiring to commit health care fraud.  According to court documents and proceedings, SAMPSON and others engaged in a scheme to defraud Medicaid, a health care benefit program, by submitting fraudulent claims for Day Treatment Services for preschool and school-aged children. Day Treatment Services are a covered Medicaid service designed to address a child’s medically necessary mental health and behavioral needs as evidenced by the presence of a mental diagnosis.  This service required the authorization of a mental health professional such as a psychiatrist, in the form of a signed service order. SAMPSON was the principal owner and manager for Country Layne Day Treatment, LLC. located in Pembroke, North Carolina.  In April 2006, SAMPSON applied for and received a Medicaid provider number and orchestrated an elaborate system for submitting fraudulent billings to Medicaid by billing for services that were not provided or were provided by unqualified individuals, falsifying service notes to hide these false billings, and creating false service orders with forged doctors’ signatures.  This activity continued through 2010.

In November of 2010, the United States Health and Human Services Office of the Inspector General (HHS-OIG), the Medicaid Investigations Division (MID) of the North Carolina Attorney General’s Office, the North Carolina State Bureau of Investigation and the United States Secret Service seized in excess of $300,000.00 in property belonging to SAMPSON; the property was purchased using Medicaid money.  All of this property has now been forfeited to the United States and included a fleet of recreational vehicles, personal vehicles, and rare motorcycles.  The seizure included two custom motorcycles, a 2008 Queen Cobra and a 2008 Bourget Cobra, valued at $89,500.00 and $69,000.00 respectively.

North Carolina Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigation 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 Russell F. Nelson, Special Agent in Charge, United States Secret Service, Charlotte Field Office join the U.S. Attorney’s Office in making today’s announcement.

Investigation of this case was conducted by The United States Department of Health and Human Services, Office of the Inspector General, the Medicaid Investigations Division of the North Carolina Attorney General’s Office, the United States Secret Service, the North Carolina State Bureau of Investigation and the North Carolina Division of Medical Assistance Program Integrity Section.  Assistant United States Attorney Thomas Murphy and Special Assistant U.S. Attorney Erica Bing of the Medicaid Investigations Division of the North Carolina Attorney General’s Office prosecuted this case. Assistant United States Attorney Steve West handled the forfeiture of these assets.