North Carolina Man Is Sentenced To Prison For Conspiring To Steal Millions From Medicaid
Leader of the Conspiracy Already Sentenced to Eight Years
CHARLOTTE, N.C. – Today, U.S. District Judge Robert J. Conrad Jr. sentenced Jerry Lewis Taylor, 55, of Wingate, N.C., to five years in prison followed by two years of supervised release, for conspiring to steal millions from Medicaid and committing tax evasion, announced Andrew Murray, U.S. Attorney for the Western District of North Carolina. In addition to the prison term imposed, Jerry Taylor was also ordered to pay more than $6.1 to North Carolina Medicaid and over $346,000 to the U.S. Internal Revenue Service as restitution.
On Tuesday, October 20, 2020, Jerry Taylor’s co-conspirator, Ameera Ali, 41, of Columbus, Ohio, was sentenced to 84 months in prison and one year of supervised release, for her role in the scheme. In July 2020, the leader of the scheme, Tony Garrett Taylor, 40, of Brooklyn, N.Y., was sentenced to 96 months in prison and two years of supervised release.
Tommy D. Coke, Inspector in Charge of the Atlanta Division of the U.S. Postal Inspection Service, which oversees Charlotte, Robert W. Wells, Special Agent in Charge of the Federal Bureau of Investigation (FBI), Charlotte Division, Matthew D. Line, Special Agent in Charge of the Internal Revenue Service, Criminal Investigation Division, Charlotte Field Office (IRS-CI), and Attorney General Josh Stein, who oversees the North Carolina Medicaid Investigations Division (MID), join U.S. Attorney Murray in making today’s announcement.
According to filed court documents and today’s sentencing hearing, from June 2015 to December 2017, Jerry Taylor and his brother, Tony Taylor, orchestrated a scheme to defraud Medicaid of more than $9.4 million by submitting false and fraudulent reimbursement claims for patient services that were either non-existent or mischaracterized to Medicaid. The brothers submitted the fraudulent claims through several companies they owned and/or operated, including Taylor Behavioral Health Center, LLC and Options Driven LLC, both located in Monroe, N.C.; Design for Change LLC located in Raleigh and elsewhere; and SHG Consultants, located in Gastonia, N.C. and elsewhere (collectively, the “the entities”). These entities specialized in providing outpatient behavioral health services to at-risk youth throughout North Carolina.
Court records show that, during the relevant time period, Jerry Taylor was responsible for overseeing certain aspects of the business operations of the entities, including managing the preparation and submission of fraudulent claims through the entities’ third-party billing company owned by Ameera Ali. According to court records, in addition to providing billing services for the conspiracy, Ameera Ali furnished Tony Taylor with prospective patient lists containing identifying information for eligible Medicaid beneficiaries. The beneficiary information obtained from Ali and others were used, in turn, to file fraudulent reimbursement claims for services that were never provided. To the extent that services were actually provided, the conspirators submitted to Medicaid fraudulent reimbursement claims that misrepresented the services rendered so as to obtain a higher reimbursement rate, a practice known as “upcoding.”
According to court documents, Tony Taylor also recruited Devon Rambert-Hairston, a licensed nurse practitioner and the director of one of the entities operated by the brothers, to review and sign-off on fictitious patient progress notes. Court records show that Rambert-Hairston never provided any behavioral health or medical services to the Medicaid beneficiaries or rarely interacted with them at all. To the extent that the beneficiaries received any treatment, those services were provided by an individual identified in court documents as J.B., who was not credentialed to provide those types of services.
Jerry Taylor and Tony Taylor also conspired with Christine Yvette Knight, who operated Connect and Move Staffing LLC in Florida. Knight’s role in the conspiracy was to create fraudulent treatment notes for the beneficiaries, and to prepare fake billing spreadsheets which were used by the brothers to further perpetuate the fraud.
During the course of the fraudulent scheme, Jerry and Tony Taylor caused hundreds of false and fraudulent claims to be submitted to Medicaid for false and fraudulent services. As a result, more than $9.4 million in fraudulent claims were submitted to Medicaid, resulting in approximately $6.1 million in fraudulent payments from Medicaid.
In addition to health care fraud, Jerry Taylor also committed tax evasion, by failing to file timely and/or accurate U.S. Individual Income Tax Returns for tax years 2016 and 2017, and failing to report more than $1.6 million in fraudulent receipts from Medicaid that were diverted to nominee entities and individuals. Jerry Taylor used the fraudulent proceeds for personal expenditure using business accounts, including to pay for medical expenses, personal travel, and to make large cash withdrawals, among other things.
In announcing Jerry Taylor’s sentence, Judge Conrad described the fraud as sophisticated and said the defendants preyed upon government institutions and taxpayers.
Devon Rambert-Hairston was previously sentenced to a year and a day in prison and a year of supervised release, and was ordered to pay $813,726 in restitution. Christine Yvette Knight has pleaded guilty to making a false statement relating to health care matters and is currently awaiting sentencing.
In making today’s announcement U.S. Attorney Murray thanked the USPIS, the FBI the IRS, and North Carolina’s MID for their investigation of this case.
Assistant U.S. Attorneys Michael Savage and William Bozin of the U.S. Attorney’s Charlotte Office are prosecuting the case.
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.