A licensed social worker from Charlotte pleaded guilty on Wednesday to conspiring to defraud Medicaid of at least $4.3 million – one of three unrelated similar schemes, prosecutors said.
Aliya Boss, 35, pleaded guilty to one count of health care fraud conspiracy in federal court.
In a separate case, licensed social worker Zaria Davis Humphries pleaded guilty on Tuesday to one count of health care fraud conspiracy for attempting to steal at least $850,000 from Medicaid, prosecutors said.
In the third case, prosecutors filed charging documents and plea agreements against two other women facing health care fraud conspiracy charges.
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Sakeenah David Davis and Kino Legette Williams are expected to enter formal guilty pleas on Dec. 4 for conspiring to defraud Medicaid of at least $1.6 million, U.S. Attorney Anne Tompkins announced.
According to court records, Boss participated in a scheme from 2012 to June 2013 to defraud Medicaid of at least $4.3 million by submitting false reimbursement claims for mental and behavioral health services she didn’t provide. Boss, a licensed social worker, is approved by Medicaid to bill for and receive reimbursement for therapy services provided to Medicaid recipients.
Court records say Boss conspired with others and agreed to allow at least two mental health companies to submit fraudulent reimbursement claims to Medicaid using her provider number for sham mental and behavioral health services she never provided.
In some instances, the fraudulent reimbursement claims said Boss provided as many as 140 hours of therapy during a single 24-hour day.
In exchange for lending her Medicaid provider number, Boss received monthly payments from the companies, even though she knew she never provided the services.
Besides “renting out” her provider number, court documents indicate that, with the help of a conspirator, Boss submitted false claims to Medicaid for fraudulent counseling services through her own company, Boss Counseling and Consulting LLC.
According to court records, Boss billed Medicaid for fraudulent therapy services using the Medicaid numbers of beneficiaries collected by another member of the conspiracy working as a “patient recruiter.” The recruiter collected the Medicaid numbers from the recipients in exchange for cash or indirectly by paying for food and taxi rides, among other things, court records show.
The conspirators then used the beneficiaries’ numbers to file the fraudulent reimbursements, claiming, in some instances, that Boss provided therapy services to more than 200 Medicaid recipients in a single day and billing for more than 64 hours of therapy over 24 hours.
Boss was released on bond following her plea. The maximum prison term for health care fraud conspiracy is 10 years and a $250,000 fine.
Boss agreed to pay restitution, the amount of which will be determined by a judge at sentencing. Her sentencing date hasn’t been set.
Humphries, 41, of Charlotte admitted to participating in a similar scheme from January to June 2013. She owns Life Impact Solutions LLC. She was released on bond and is awaiting sentencing. She also faces a maximum 10 years in prison and a $250,000 fine.
Davis, 37, and Williams, 36, also of Charlotte, owned and operated New Choices Youth and Family Services, a Medicaid-approved company that purportedly provided outpatient mental and behavioral therapy services.
They used some of the stolen funds to pay for personal expenses, including jewelry, and for Davis’s wedding, prosecutors said.