A Shelby, North Carolina woman pleaded guilty today for her
involvement in a health care fraud scheme that defrauded Medicaid of $8
million for sham mental and behavioral health services, announced Anne
M. Tompkins, U.S. Attorney for the Western District of North Carolina.
In addition to defrauding Medicaid, Victoria Finney Brewton, 37, also
pleaded guilty to stealing a therapist’s identity to commit the fraud
and to filing a false tax return.
U.S. Attorney Tompkins is joined in making today’s announcement by
North Carolina Attorney General Roy Cooper, who oversees the North
Carolina Medicaid Investigations Division (MID); Roger A. Coe, Acting
Special Agent in Charge of the FBI, Charlotte Division; Jeannine A.
Hammett, Special Agent in Charge of the Internal Revenue Service,
Criminal Investigation Division (IRS-CI); and Derrick Jackson, Special
Agent in Charge, Department of Health and Human Services, Office of the
Inspector General (HHS-OIG), Office of Investigations, Atlanta Region.
Brewton pleaded guilty today before U.S. Magistrate Judge David
Keesler to seven counts of health care fraud and health care fraud
conspiracy, one count of aggravated identity theft, and one count of
filing a false tax return. At today’s plea hearing, the defendant
admitted that from 2008 to 2012, Brewton, her co-defendant Linda
Radeker, also of Shelby, and others submitted in excess of $8 million
in false claims to Medicaid. According to filed court documents and
statements made in court, Brewton operated a series of after-school and
summer childcare programs in Shelby. Brewton recruited juvenile
Medicaid recipients to her childcare programs by promising that the
program would be free for Medicaid recipients. After Brewton obtained
the children’s and families’ Medicaid recipient numbers, she used this
information to fraudulently bill Medicaid for mental and behavioral
health services that were never provided.
According to the criminal information, Brewton was not licensed or
qualified to provide mental and behavioral health services, and she was
not approved by Medicaid. Instead, Brewton enlisted the assistance of
other complicit Medicaid-approved providers, such as Linda Radeker and,
in other instances, stole the identity of Medicaid-approved providers
in order to accomplish the fraud. Court documents indicate that Brewton
conspired with Radeker, a licensed professional counselor enrolled
with North Carolina Medicaid, to submit claims to Medicaid making it
appear that Radeker had provided the claimed mental and behavioral
health services when, in fact, Radeker did not provide any of the
services. Radeker and Brewton then split the Medicaid payments 50/50
for these false claims.
Filed documents also indicate that Brewton hired licensed therapist
K.S.M. in October 2010 to provide services at Brewton’s company,
Healing Hearts. Although K.S.M. provided some mental and behavioral
health services while she worked at Healing Hearts, Brewton submitted
false and fraudulent claims to Medicaid through K.S.M.’s Medicaid
provider number far in excess of the services actually provided by
K.S.M. In or about October 2011, K.S.M. left Healing Hearts after
learning that Brewton had submitted false claims through K.S.M.’s
Medicaid provider number. Thereafter, Brewton misappropriated K.S.M.’s
identity, specifically her Medicaid provider number, in order to
continue to submit fraudulent claims to Medicaid after K.S.M. was no
longer employed at Healing Hearts. Specifically, the defendant admitted
that on or about October 27, 2011, Brewton submitted an Electronic
Funds Transfer Authorization Agreement to Medicaid directing that
reimbursements for claims submitted through K.S.M.’s provider numbers
be deposited into a bank account held and controlled by Brewton. From
in or about April 2011 to May 2012, Brewton submitted in excess of $1.8
million in false claims through K.S.M.’s provider number which K.S.M.
did not provide. According to court documents, Brewton also misused the
Medicaid provider numbers of other therapists employed by her
companies in order to submit false claims to Medicaid through their
numbers.
As part of her plea, Brewton also admitted that she defrauded the
United States by filing a false tax return for the year 2009 that
intentionally failed to report the income Brewton received from her
scheme to defraud Medicaid. She also failed to file tax returns for
2010 and 2011, which further masked the income from her fraud scheme.
Brewton agreed to forfeit a 2005 Dodge Magnum which was seized as the
proceeds of fraud during the investigation.
Brewton, who was released on bond, faces a mandatory two years in
prison consecutive to any other term of imprisonment and a $250,000
fine for the aggravated identity theft charge, a maximum term of 10
years in prison, and a $250,000 fine for the health care fraud charges;
and a maximum term of three years in prison and a $250,000 fine for
the filing of a false tax return charge. In her plea agreement, Brewton
has agreed to pay full restitution to Medicaid for any losses
resulting from her criminal scheme. The final restitution amount will
be determined by the court at Brewton’s sentencing hearing, which has
not been scheduled yet.
Radeker pleaded guilty to charges of health care conspiracy and
money laundering on September 13, 2012, and is awaiting sentencing.
The investigation into Brewton was handled by the FBI, MID, IRS, and
HHS-OIG. Special assistance to the task force was provided by the
North Carolina Division of Medical Assistance, Program Integrity
Section. The prosecution was handled by Assistant U.S. Attorneys Kelli
Ferry and Jenny Grus Sugar of the U.S. Attorney’s Office in Charlotte.
The investigation and charges are the work of the Western District’s
joint Health Care Fraud Task Force. The task force is multi-agency
team of experienced federal and state investigators, working in
conjunction with criminal and civil Assistant United States Attorneys,
dedicated to identifying and prosecuting those who defraud the health
care system, and reducing the potential for health care fraud in the
future. The task force focuses on the coordination of cases,
information sharing, identification of trends in health care fraud
throughout the region, staffing of all whistleblower complaints, and
the creation of investigative teams so that individual agencies may
focus their unique areas of expertise on investigations. The task force
builds upon existing partnerships between the agencies, and its work
reflects a heightened effort to reduce fraud and recover taxpayer
dollars.
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