Saturday, December 2, 2023

Charlotte health care provider accused of Medicaid, COVID-19 fraud

A federal grand jury indicted a Charlotte behavioral health services provider on 16 Medicaid and COVID-19 fraud charges.

Ashley Nicole Cross, 41, has been indicted on healthcare fraud, making false writings relating to a healthcare matter, making false statements relating to a healthcare matter, promotion of money laundering, wire fraud, wire fraud conspiracy and wire fraud affecting a financial institution.

Cross declined to comment on the charges against her.

The Healthcare Fraud Scheme

The federal indictment alleges Cross owned and operated Odyssey Health Group, a Charlotte-based company, that was enrolled with South Carolina Medicaid and provided outpatient behavioral health services to eligible Medicaid beneficiaries in South Carolina.

From 2016 to 2021, Cross carried out a healthcare fraud scheme involving the fraudulent submissions of fraudulent reimbursement claims to South Carolina Medicaid and its contracted managed care organizations for rehabilitative behavioral health services that were never provided.

The indictment alleges that Cross paid for the personal identifying information of qualified South Carolina Medicaid beneficiaries. Cross then allegedly used the information to file fraudulent reimbursement claims totaling at least $400,000.

To further the scheme and to give the appearance that OHG’s fraudulent claims were legitimate, Cross allegedly instructed OHG employees to create fictitious patient files and clinical service notes in the names of beneficiaries.

According to allegations in the indictment, in September 2019, Cross was informed of an audit into OHG’s claims. The indictment alleges that Cross submitted fictitious patient medical records and made false statements to the auditor in order to cover up the fraud.

The indictment also alleges that Cross engaged in money laundering and used some of the fraudulent proceeds to promote the scheme by paying for Medicaid beneficiary names and PII.

The COVID-19 Fraud Scheme

According to allegations in the indictment, 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., a purported event planning business owned by a co-conspirator.

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

As a result of the fraudulent PPP loan applications and supporting documents, Cross and her coconspirator obtained more than $120,000 in COVID-19 relief funds for OHG and Gucci. At the time of Gucci’s loan application, the company’s owner was under indictment for a federal offense.

A summons has been issued, and Cross will appear in federal court for her initial appearance. The healthcare fraud offense carries a maximum penalty of 10 years in prison for each count in the indictment.

The offense of making false writings and false statements relating to a healthcare matter carries a maximum prison sentence of five years. The promotion money laundering and wire fraud charges each carry a maximum statutory sentence of 20 years in prison per count.

And the charge of wire fraud conspiracy affecting a financial institution carries a maximum penalty of 30 years in prison.

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