A Cary man was sentenced to 12 years and seven months in federal prison for a health care scheme that involved a behavioral health service in Dunn.
Antonio Deon Fozard pleaded guilty to charges of conspiracy and health care fraud. In addition to his prison sentence, he was ordered to serve three years of supervised release and pay $4,242,794 in restitution to the North Carolina Fund for Medical Assistance.
“This defendant stole millions intended to provide healthcare to low-income families,” said U.S. Attorney Michael Easley. “We will continue to investigate and prosecute those that mastermind these unconscionable schemes to misuse taxpayer funds meant to help those in need.”
Prosecutors say Fozard led a multi-district conspiracy to defraud the North Carolina Medicaid system by submitting more than $7 million in false and fraudulent claims for the reimbursement of behavioral health services. The submissions reportedly occurred between 2012 and 2017.
Fozard owned and operated a number of behavioral health companies that purported to provide services to Medicaid beneficiaries in the middle and eastern districts of North Carolina, according to a release from Easley’s office. The companies operated under the names Group Service, Group Service Solution, Zoofari Kids, and In Touch of Care.
Prosecutors say each of these entities engaged in a systematic effort to steal from Medicaid by billing for services that were never rendered.
“Group Service maintained offices at various times in Raleigh, Dunn, Durham and Sanford,” stated Easley’s release. “Among other things, Group Service employed co-conspirators Reginald Van Reese, Jr., and Ruben Samuel Matos to canvas low-income neighborhoods to identify eligible Medicaid recipients and collect their personal identifying information (PII), including their Medicaid identification numbers.
“The harvested PII was then incorporated into false and fraudulent claims that Group Service submitted to Medicaid for reimbursement,” the release stated. “Various ‘note writers,’ including co-conspirator Humberto ‘Ghost’ Mercado, were enlisted to fabricate supporting documentation in the event of a Medicaid audit. At one point during the conspiracy, Group Service was audited by a Medicaid contractor. To obstruct the audit, Fozard directed note writers to fabricate medical records and then caused those records to be provided to investigators.”
Prosecutors say Fozard and another co-conspirator, Sharita Mathis Richardson, were similarly defrauding N.C. Medicaid through the operation of Zoofari Kids during the same time period. Zoofari operated in Durham and Garner.
The Durham location shared the same address as Group Service and purported to provide mental health treatment to Medicaid recipients, according to Easley’s release. “The Garner location was strictly a drop-in daycare facility. The daycare, however, was effectively funded by Medicaid fraud proceeds paid out to Zoofari’s mental health business. Under Fozard’s leadership, Zoofari filed thousands of false claims in the name of a rendering provider whose information was used without his knowledge or consent, obtained lists of stolen Medicaid beneficiary information for incorporation into the fraudulent billings, and created fake medical records.
“After Group Service was barred from billing Medicaid, Fozard engaged in another billing scheme through a different business, In Touch of Care,” Easley noted in his release. “According to the investigation, In Touch of Care recycled Medicaid information from fraudulent billings submitted by prior Fozard-controlled entities. Additionally, Fozard caused In Touch of Care to bill for services using the clinician information for a nurse practitioner who never performed the listed services.
“In addition to engaging in health care fraud through businesses under his direct control, Fozard collaborated with third party owners and operators of other purported behavioral health companies for the purpose of cheating the Medicaid system,” according to Easley’s release. “For example, Fozard conspired with brothers Jerry and Tony Taylor, the owners of Taylor Behavioral Health and Options Driven in Monroe, North Carolina, by selling them lists of stolen Medicaid beneficiary information for use in their own fraudulent billings.”
Reginald Van Reese Jr., Ruben Samuel Matos, Humbert Mercado and Sharita Mathis Richardson, each pleaded guilty to health care fraud charges and were sentenced to prison in related cases filed in the Eastern District of North Carolina. Co-conspirators Jerry and Tony Taylor pleaded guilty to heath care fraud charges and were sentenced to prison in related cases filed by the United States Attorney’s Office for the Western District of North Carolina.
Medicaid is a federally funded health care benefit program that helps pay for medical services for low-income individuals and their families. In North Carolina, Medicaid is administered by the North Carolina Department of Health and Human Services, Division of Health Benefits.