SC DAILY GAZETTE – Eleven people were charged with defrauding government health insurance programs in South Carolina using schemes that raked in more than $23 million, according to the U.S. Attorney’s Office.
The charges were part of a national investigation billed as the largest in history. All told, 324 people across the country were charged with submitting false billing statements amounting to more than $14.6 billion and diverting more than 15 million pills containing controlled substances, the U.S. Attorney’s Office said.
The alleged schemes in South Carolina involved falsified reimbursement claims that in some cases originated in other states but targeted the Palmetto State’s Medicare and Medicaid programs, as well as the federal Department of Veterans Affairs, according to a news release.
“Health care fraud steals from the American taxpayer and harms the systems meant to serve those in need,” said Bryan Stirling, acting U.S. attorney in South Carolina. “The cases in South Carolina, like those nationwide, demonstrate our unwavering commitment to protecting vulnerable citizens, especially our veterans, and ensuring the integrity of programs designed to care for them.”
Two of the cases will be litigated in South Carolina’s federal court. Eight cases involving the Palmetto State will go through the Western District of North Carolina because the scheme took place primarily in Charlotte. One was filed in South Carolina state court, according to a list of cases nationwide.
A $21 million scheme
Between 2017 and 2024, eight people established nine fake behavioral health clinics in North Carolina and enrolled them in South Carolina’s Medicaid program through a program that allows people using Medicaid to visit doctors within 25 miles of the state line, according to the U.S. Attorney’s Office.
Three of the people charged lived in South Carolina. Others lived in North Carolina and Georgia, according to the office.
Once the businesses were enrolled in the Medicaid program, the defendants would obtain real names and identification numbers of licensed medical professionals.
Most of the medical professionals whose names and identification numbers were used didn’t know about the scheme. The people running the clinics would get their information from job applications for the fake clinics and by hiring them to review clinical notes — a task that doesn’t require actually meeting with patients, according to the indictment.
The patients supposedly coming to the clinics for treatment were sometimes real and sometimes fake. None of the real patients actually came to the clinics, but the owners paid people with legitimate access to the state’s Medicaid rolls between $200 and $300 per name provided, using about 180 real names in total, according to court filings.
Using those names and identification numbers, the owners of the fake clinics would submit false reimbursement requests for services not actually performed. In some cases, the services couldn’t possibly have happened, since they added up to more than 24 hours of service per day for a single health care provider or covered dates from before a person was deemed eligible for Medicaid, according to the indictment.
Altogether, the fake clinics in North Carolina received more than $21 million in reimbursements from South Carolina’s Medicaid program for services not actually performed, according to the indictment. The conspirators then transferred that money from bank account to bank account in a way that constituted money laundering, the U.S. Attorney’s Office claimed.
One of the defendants in the scheme, North Carolina resident David Hill, has agreed to plead guilty, according to the state Attorney General’s Office.
Services to veterans
As an approved health care provider under the federal Veterans Affairs department, Dee Moton’s massage therapy company Flowing Hands, located in Aiken, was allowed to provide certain health care services to veterans who received referrals.
What Moton, a 51-year-old from Georgia, submitted to the company with which she contracted, however, did not align with the services she provided, leading to charges of health care fraud, according to a federal indictment.
Many of her submissions for reimbursements involved mutually exclusive reimbursement codes. Others were for services she couldn’t have performed, such as wheelchair therapy to patients who did not use wheelchairs, aquatic therapy despite the clinic not having a pool, and remote monitoring of pacemakers for patients who didn’t have pacemakers, according to the indictment.
Over two years, Moton billed the Veterans Administration for more than $2.3 million for services she didn’t actually perform, claimed the state’s U.S. Attorney’s Office, which will prosecute the case.
It’s unclear who is representing Moton, who could not be immediately reached for comment.
False equipment claims
Tina Armstrong, a 67-year-old woman from Florence, was charged with submitting nearly $200,000 to the state’s Medicaid and Medicare programs for medical equipment that was no longer in use, never authorized or not delivered, according to the U.S. Attorney’s Office.
Armstrong pleaded not guilty, according to court filings.
An indictment listing her charges claimed she received about $105,000 from the claims.
Under the company Safe at Home Medical Equipment and Supplies, located in Dillon County, Armstrong submitted claims for equipment for patients who had died or didn’t use the equipment she claimed they needed and asked for reimbursements for monthly rentals long after the time limits established in federal law had passed, according to the indictment.
Financial fraud
Latisha Massey, a 37-year-old certified nursing assistant, was charged in state court with financial crimes involving the nursing home where she worked, according to an indictment.
The Greer resident transferred funds from the bank account of an adult in her care to her own account and used a card belonging to a resident of the facility where she worked, according to the indictment.
The indictment did not include the amounts Massey is charged with transferring. The state Attorney General’s Office will prosecute her case because — unlike the others — the alleged crimes do not cross state lines.
A message on a phone believed to be Massey’s was not immediately returned.
