Local nurse admits guilt in Medicaid fraud case

Published 10:34 am Monday, September 25, 2017

RALEIGH – A local licensed nurse practitioner faces up to five years in prison as well as a fine as much as $25,000 after pleading guilty to accepting illegal remunerations in a federal fraud case.

On Wednesday, 62-year-old Christine Hicks Thomas of Murfreesboro entered a plea of guilty while appearing in Federal Eastern District Court of North Carolina in Raleigh.

According to U.S. Attorney John Stuart Bruce, the terms of the plea agreement include Thomas surrendering her nursing license, to surrender any interest she has in companies that bill the government for health care services, and to be permanently excluded from Medicare and Medicaid programs, in addition to the possible prison term and fines.

According to the criminal information and evidence discussed in open court, Thomas agreed to sign off on orders authorizing various Medicaid recipients to receive outpatient behavioral health services. In fact, Thomas never evaluated the patients or made any clinical assessment of whether the services were medically necessary for the recipients, as noted in Federal Court.

In a recorded encounter in a parking lot, Thomas accepted a cashier’s check in exchange for signing the orders.

The orders that Thomas signed are required by Medicaid’s Managed Care Organizations as a prerequisite before a Medicaid provider can bill the government for outpatient behavioral health services. Once authorization orders are signed, providers can lawfully bill the government for hundreds of thousands of dollars in outpatient behavioral health services, provided such services are actually rendered.

Meanwhile, Bruce noted that this case is part of a broader investigation of a Medicaid fraud conspiracy carried out by Terry Lamont Speller, Donnie Lee Phillips, II, and Shephard Lee Spruill, II, whose cases have already been sentenced.

Speller, age 38 of Winterville, was sentenced in March of 2016 to 20 years in prison after he pled guilty to Health Care Fraud, and Engaging in Monetary Transactions in Criminally Derived Property.  Speller was also ordered to make restitution of $5,962,189.77 to the victims of the offense, which included the North Carolina Medicaid program and a physician, whose name and identification number Speller used to commit the fraud.

The criminal information to which Speller pled guilty provides that between 2010 and 2015, he was an individual doing business through various Outpatient Behavioral Health and Outpatient Health Service providers in Pitt County and surrounding areas within the Eastern District of North Carolina.  Through these providers, Speller recruited hundreds of Medicaid beneficiaries, mostly children, from various communities in Eastern North Carolina to receive alleged services compensable by Medicaid. An investigation revealed that at least one of Speller’s companies was billing Medicaid for services that were not rendered.

Later, when the case was building against Speller – to include his use of the names of other providers, some of which were operated through companies placed in the names of close family members, to continue to submit fraudulent claims – it was revealed that he threatened to kill a witness against him in May of 2015.  Evidence at the sentencing hearing showed that when the witness indicated that they would testify against Speller, he drove the witness off of a roadway and displayed a firearm. Speller was arrested shortly thereafter on a federal warrant, and has been in custody since that time.

Phillips, age 37 of Greenville, was sentenced in December of last year to nine years in prison and also ordered to make restitution of $5,722,364.09 for his role in Health Care Fraud Conspiracy and Aggravated Identity Theft. He was further ordered to forfeit certain proceeds of the fraud, including a truck, boat, and boat trailer.

His case was part of Speller’s case involving health care fraud and money laundering.

The criminal information to which Phillips pled guilty showed that he fraudulently billed the Medicaid program and Medicaid Managed Care Organizations for services that were not, in fact, provided by various outpatient behavioral health providers. Phillips transmitted false billings on behalf of various individuals in the scheme and, in the process, fraudulently utilized the identities of more than 2,000 minor children.

Before being caught carrying out the fraud on audiotape by a confidential informant, Phillips assisted participating providers to fraudulently acquire more than $5 million. For his role in the scheme, Phillips received around $300,000.

Spruill, age 46 of Winterville, received a 15-year prison term upon sentencing in August of this year. He pled guilty to Conspiracy to Commit Health Care Fraud, and Perjury. Spruill was also ordered to make restitution in the amount of $1,846,377 to the North Carolina Medicaid program, as well as additional restitution for any other fraud committed by or through Medicaid providers Pride in North Carolina, Carolina Support Services, Elite Care, Southern Support Services, One to One Youth, Vision of New Hope, Bridge Builders Youth Services, and Jameson Consultants.

About Cal Bryant

Cal Bryant, a 40-year veteran of the newspaper industry, serves as the Editor at Roanoke-Chowan Publications, publishers of the Roanoke-Chowan News-Herald, Gates County Index, and Front Porch Living magazine.

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