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Defendant Allegedly Obtained Over $450,000 for Fraudulent and Non-Existent Services
CHARLOTTE, N.C. – A Charlotte man charged with defrauding Medicaid of at least $450,000 and stealing the identities of children and clinicians to commit the fraud was arrested in Charlotte today, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina.
A federal grand jury returned the criminal indictment against Calvin Cantrell Estrich, 31, of Charlotte on May 23, 2013. The indictment charges Estrich with one count of health care fraud conspiracy, four counts of health care fraud, four counts of false statements in connection with health care matters, eight counts of aggravated identity theft, one count of money laundering and one count of making false statements to investigators. The indictment also includes a forfeiture allegation seeking a money judgment in the amount of at least $462,178.
U.S. Attorney Tompkins is joined in making today’s announcement by Attorney General Roy Cooper, who oversees the North Carolina Medicaid Investigations Division (MID).
“Rooting out health care fraud and bringing to justice those looking to scam taxpayer-funded health care programs is a priority for this office,” said U.S. Attorney Tompkins. “Since its inception in 2010, our District’s Health Care Fraud task force has prosecuted a significant number of criminals who sought to benefit financially by falsely billing Medicare and Medicaid. We will continue to fight health care fraud through concentrated and sustained efforts and to aggressively safeguard precious taxpayer dollars.”
“Cases like this one send a strong signal that we won’t tolerate health care fraud in North Carolina,” said Attorney General Roy Cooper. “Our investigators and attorneys will continue to work closely with their federal counterparts to stamp out health care fraud and abuse, save taxpayers’ money, and protect patients.”
According to allegations in the indictment, from October 2009 through November 2010 Estrich and his co-conspirator, Joye Strong, participated in a scheme to defraud Medicaid by submitting reimbursements for medically unnecessary services. Estrich’s company, Everyday’s Blessing, was approved by Medicaid to provide Intensive In-Home Community Intervention Services, which are mental and behavioral services designed to stabilize living arrangements and prevent out-of-home therapeutic treatment for children and youth. The indictment alleges that Estrich and Strong stole and misused the identities of a nurse practitioner and two therapists in order to complete the necessary paperwork for Medicaid to approve services for Medicaid recipients to receive these services. According to the indictment, once Medicaid approved Everyday’s Blessing to provide services to these recipients based upon the fraudulent paperwork, Estrich and Strong sought and received reimbursement from Medicaid through Everyday’s Blessing for the medically unnecessary services. The indictment also alleges that in many instances, the Medicaid recipients did not receive any services at all.
For example, the indictment alleges that Estrich, aided and abetted by others, fraudulently billed Medicaid for services supposedly provided to juvenile Medicaid recipient, identified in the indictment as “J.R.” when, in fact, J.R. did not receive any services. Estrich and Strong, through Everyday’s Blessing, received over $24,000 in payments from Medicaid for these false services. Furthermore, Estrich unlawfully used J.R.’s Medicaid recipient identification number in order to obtain reimbursement pursuant to the fraud scheme.
The indictment further alleges that Estrich and Strong stole the identity of a therapist, identified in the indictment as “J.O.,” in order to obtain approval from Medicaid for fraudulent and medically unnecessary services. According to the indictment, J.O. provided her name and credentials to co-conspirator Strong when J.O. sought employment at another company operated by Strong. Thereafter, Estrich and Strong stole and misused J.O.’s identity by forging J.O.’s signature on paperwork for diagnostic and therapeutic services which J.O. did not perform.
According the indictment, Estrich and Strong obtained $462,178 in fraudulent payments from Medicaid pursuant to the fraud scheme. During the relevant time period, the indictment alleges that Estrich laundered the proceeds of the fraud scheme through cash withdrawals and debit card purchases, including a cash withdrawal in the amount of $15,093 in November 2010. Furthermore, the indictment alleges that when investigators interviewed Estrich about the fraud scheme in December 2012, Estrich made materially false and fraudulent statements to investigators.
Co-conspirator Joye Strong pleaded guilty to eight counts of health care fraud and two counts of money laundering in October 2011. Strong is awaiting sentencing on those charges. U.S. Attorney Tompkins notes that the guilty plea of one any other person is not relevant to the guilt of any indicted person.
Estrich made his initial appearance today in U.S. District Court and was released on bond. If convicted, Estrich faces a maximum of ten years in prison for the health care fraud conspiracy count and for each of the four counts of health care fraud. He faces a maximum prison term of five years for each of the four counts of making false statements in connection with health care matters. He also faces a mandatory consecutive prison term of two years for the eight aggravated identity theft counts, ten years on the one count of money laundering and five years on the one count of making false statements to investigators in a federal health care fraud investigation. Each of the counts charged in the indictment carries a maximum fine of $250,000.
An indictment is merely an allegation and Estrich is presumed innocent unless and until proven guilty beyond reasonable doubt in a court of law.
The investigation into Estrich and Strong was handled by MID with assistance from the North Carolina Division of Medical Assistance. The prosecution is being handled by Special Assistant United States Attorney Laura Lansford and Assistant U.S. Attorney Kelli Ferry of the Western District of North Carolina.
Ms. Lansford is an Assistant Attorney General with the North Carolina Department of Justice Medicaid Investigations Division and was appointed to serve as a Special Assistant United States Attorney (SAUSA) with the U.S. Attorney’s Office in Charlotte in 2007. The SAUSA position is reflection of the partnership between the Medicaid Investigations Division and the United States Attorney that helps ensure the effective and vigorous prosecution of Medicaid fraud.
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 prosecutors, 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. To report Medicaid fraud in North Carolina, call the North Carolina Medicaid Investigations Division at 919-881-2320.