Wednesday, June 19, 2024

Charlotte business owner convicted of Medicaid, COVID fraud

A federal jury convicted a Charlotte behavioral health services provider on charges related to Medicaid and COVID-19 relief fraud, as well as money laundering, after a nine-day trial, according to the U.S. Attorney’s Office in Charlotte.

Ashley Nicole Cross, 41, of Charlotte, was taken into custody after the guilty verdict and now awaits sentencing. The jury found Cross guilty of defrauding the South Carolina Medicaid Program, making false statements and writings relating to a healthcare matter, promotional money laundering, wife fraud and conspiracy.

According to trial evidence – including 25 witnesses and more than 600 documents – Cross owned Odyssey Health Group, which was enrolled with S.C. Medicaid to provide outpatient behavioral health services.

From 2016 to 2021, Cross’s company submitted fraudulent reimbursement claims to S.C. Medicaid and its contracted managed care organizations for rehabilitative behavioral health services that were never provided.

To carry out the scheme, Cross used the personal identifying information of qualified S.C. Medicaid beneficiaries to file reimbursement claims totaling $1.3 million. For some claims, Cross bought the personal identifying information of Medicaid beneficiaries she used to submit claims.

To further the scheme and to give the appearance that the fraudulent claims were legitimate, Cross instructed her employees to create fake clinical service notes after she filed fraudulent claims in the names of Medicaid beneficiaries.

Cross learned in September 2019 of audits of her company’s Medicaid claims. To cover up the fraud, Cross submitted fictitious patient medical records and made false statements to auditors. Trial evidence further established that Cross engaged in money laundering and used some of the fraudulent proceeds to promote the scheme by paying for Medicaid beneficiary names and personal identifying information.

In addition to Medicaid fraud, evidence showed that from April 3, 2020, to May 14, 2022, Cross executed a scheme to obtain fraudulent Paycheck Protection Program loans on behalf of OHG and Gucci International Inc. (Gucci), a purported event planning business owned by Cross’s boyfriend and co-conspirator.

To obtain the COVID-19 business loans, Cross submitted loan applications and supporting documents that contained false statements regarding OHG’s and Gucci’s payroll expenses, number of employees and other misrepresentations.

Cross obtained more than $287,000 in COVID-19 relief funds for her companies and Gucci. At the time of Gucci’s loan application, Cross’s boyfriend was under indictment for a federal offense.

A federal District Court judge will determine Cross’s sentence under federal sentencing guidelines and other statutory factors. A sentencing date has not been set.

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