Two More Health Care Executives Plead Guilty in Connection with Medicaid Behavioral Health Fraud
RALEIGH – United States Attorney Robert J. Higdon, Jr. announced that today in federal court, LISA CAROL RAYMOND, 55, of Greenville, North Carolina, and ROBERT PAUL MAGLICIC, JR., 36, of Miami, Florida, pleaded guilty before Chief United States District Judge Terrence W. Boyle, to the charge of Conspiracy to Commit Health Care fraud, in violation of Title 18, United States Code, Section 1349.
Based upon the Criminal Information and facts offered at the plea hearing today, MAGLICIC and RAYMOND participated in a scheme to defraud the South Carolina Medicaid program through a provider known as Southern Support Services. Southern Support Services was owned by Shepard Lee Spruill, who was previously prosecuted for health care fraud for defrauding the North Carolina Medicaid Program and sentenced in July of 2018 to serve 96 months in federal prison. Although the scheme in the present case concerned a fraud upon the South Carolina Medicaid program, the participants committed portions of the scheme from Greenville, North Carolina, using the stolen names and identifiers of North Carolinian employees.
United States Attorney Higdon stated, “ False billings to the Medicaid program steal money from the most vulnerable in our society – squandering precious taxpayer dollars for personal gain. The Department of Justice remains committed to holding health care executives accountable when they abuse the trust of the Medicare and Medicaid program.”
During times material to the case, MAGLICIC was Spruill’s Regional Director of Operations at, among other providers, Carolina Support Services and Southern Support Services. RAYMOND was the Corporate Office Manager for Carolina Support Services and Southern Support Services.
The evidence showed that between October of 2013 and November of 2014, Southern Support Services had fraudulently billed the South Carolina Medicaid program for more than $595,000 in fictitious behavioral health services. When approached by a Medicaid auditor in 2014 concerning the billings, MAGLICIC and RAYMOND helped fabricate records to support the prior billings. Thereafter, between December of 2014 and April of 2015, the Medicaid program paid Southern Support Services an additional $1.4 Million for behavioral health services that did not, in fact, occur.
In March of 2015, the South Carolina Medicaid program conducted another audit of Southern Support Services, this time requesting records to support billings for 160 different patients. Instead of admitting that the services were fraudulent, MAGLICIC oversaw the fabrication of all of the records requested. To carry out the scheme, MAGLICIC and RAYMOND used employee names and identifiers from Spruill’s North Carolina provider, Carolina Support Services, to create fake employee profiles for Southern Support Services. Medical records were then fabricated to justify all of the prior billings to Medicaid, making it appear that various individuals were in South Carolina assisting patients when, in fact, the individuals never worked at Southern Support Services. RAYMOND fraudulently affixed the fictitious employee signatures onto the fake records, and MAGLICIC delivered them to the MEDICAID auditors.
In total, the scheme resulted in losses to the Medicaid program totaling more than $2 Million during the period of time when MAGLICIC and RAYMOND were involved.
At sentencing, MAGLICIC and RAYMOND will face up to 10 years in prison for their participation in the health care fraud at Southern Support Services. Both defendant’s also face fines, supervised release, and mandatory restitution.
The investigation of this case was conducted by the United States Department of Health and Human Services Office of the Inspector General, the North Carolina Attorney General’s Office Medicaid Investigations Division, and the Internal Revenue Service Criminal Investigation. Assistant United States Attorney William M. Gilmore, of the United States Attorney’s Office, represented the United States. Special Assistant United State Attorney, Daniel Spillman, of the North Carolina Attorney General’s Office Medicaid Investigations Division, also represented the United States.