A North Carolina Based Medical Physician Convicted for Scheming to Defraud North Carolina Medicaid Program

A North Carolina Based Medical Physician Convicted for Scheming to Defraud North Carolina Medicaid Program

The mastermind of the Scheme Already convicted to a 96-month Imprisonment Term.

Charlotte, North Carolina – On 22nd October 2020, U.S. Attorney Andrew Murray for the Western District of North Carolina reported that Robert J. Conrad Jr. U.S. District Judge, convicted Jerry Lewis Taylor, from Wingate, New Carolina, age 55, to a 5-year imprisonment term followed with a 2-year probation term after his release, for scheming to defraud millions of USD from the Medicaid and committing tax evasion. Besides the imposed prison terms, Jerry Taylor was directed to reimburse over 6.1 million USD to North Carolina Medicaid program and more than 346,000 USD as restitution to the United States Revenue Service.

On Tuesday, 20th October 2020, Ameera Ali, Jerry Taylor’s co-schemer, from Columbus, Ohio, age 41, was convicted to a 7-year imprisonment term and a one-year probation sentence for his role in the conspiracy. In July 2020, Tony Garrett Taylor, the conspiracy leader from Brooklyn, New York, age 40, was convicted to an 8-year imprisonment term and a 2-year probation sentence after his release.

On 22nd October 2020, Inspector in Charge Tommy D. Coke of the Atlanta Division of the U.S. Postal Inspection Service which supervises Special Agent in Charge Robert W. Wells of the FBI (Federal Bureau of Investigation), Charlotte Division, Charlotte; Special Agent in Charge Matthew D. Line of the IRS-CI (Internal Revenue Service, Criminal Investigation Division), Charlotte Field Office; and Josh Stein, Attorney General, who supervises the North Carolina MID (Medicaid Investigations Division) joined United States Attorney Murray in making the announcement.

As per the court affidavits and the 22nd October 2020 conviction hearing, Jerry Taylor and Tony Taylor, his brother, masterminded a conspiracy to defraud the Medicaid program of over 9.4 million USD by submitting fraudulent and deceitful reimbursement claims for patient services that were either non-existent or mischaracterized to Medicaid program, from June 2015 to December 2017. The two brothers presented the fraudulent claims through numerous firms they operated or owned, such as Options Driven, LLC and Taylor Behavioral Health Center, LLC, both situated in Monroe, North Carolina; Designs for Charge, LLC, situated in Raleigh and elsewhere; and SHG Consultants, situated in Gastonia, North Carolina and elsewhere (collectively, “the entities”). These entities mentioned above specialized in offering outpatient behavioral health care services to at-risk youth all over North Carolina.

Court affidavits reveal that Jerry Taylor was responsible for supervising certain business operations aspects of these entities, such as managing the submission and preparations of the deceitful claims through the entities’ third-party billing firm owned and run by Ameera Ali, during the applicable time period. Besides offering billing services for the Scheme, Ameera Ali supplied Tony Taylor with a prospective patient list containing eligible Medicaid beneficiaries’ identifying information as per the court affidavits. The Medicaid beneficiaries’ identifying information received from Ameera Ali and others were utilized, in turn, to submit fraudulent and deceitful reimbursement claims for unprovided services. To the extent that services were actually offered, the schemers submitted fraudulent reimbursement claims that falsified the services offered to Medicaid so as to receive a higher reimbursement rate, an exercise known as upcoding.

As per the court affidavits, Tony Taylor also enrolled Devon Rambert-Hairston, a certified nurse professional and the director of one of the two brothers’ entities, to review and rubber-stamp fabricated patient progress notes. Court documents reveal that Rambert-Hairston never offered any behavioral health or medical services to the Medicaid beneficiaries or hardly interacted with them at all. To the extent that Medicaid beneficiaries obtained any treatment, those services were offered by a person identified in court affidavits as J.B., who was not credentialed to offer those types of services.

Tony Taylor and Jerry Taylor further schemed with Christine Yvette Knight, who runs Move Staffing, LLC, and Connect in Florida. Christine Yvette Knight’s role in the scheme was to create fraudulent treatment records for beneficiaries and generate and prepare falsified billing spreadsheets used by the two brothers to commit the fraud conspiracy further. 

During the deceitful and fraudulent scheme, Jerry Taylor and Tony Taylor created hundreds of fraudulent and deceitful claims to be submitted to the Medicaid program for fraudulent and false services. Due to these actions, over 9.4 million USD in deceitful claims were submitted to the Medicaid program, resulting in nearly 6.1 million USD in deceitful reimbursement from the Medicaid program.

Besides health care fraud, Jerry Taylor also executed tax evasion by failing to file accurate and/or accurate United States Individual Income Tax Returns for 2016 and 2017 tax years and failing to report over 1.6 million USD in deceitful and fraudulent receipts from Medicaid program that were channeled to nominee entities and persons. Jerry Taylor used the deceitful and fraudulent profits for personal expenditure using business accounts, including to reimburse for medical costs, personal travel, and to make large cash withdrawals, among other things.

When announcing Jerry Taylor’s conviction, Judge Conrad described the fraud scheme as sophisticated and stated that the accused persons preyed upon taxpayers and government institutions.

Devon Rambert-Hairston was previously convicted to a one year and day imprisonment and a one-year probation sentence upon release and was directed to reimburse restitution of 813,726 USD. Christine Yvette Knight has admitted quilt to making a falsified and deceitful statement associating with health care matters and is currently awaiting conviction.

United States Attorney Murray, when making the announcement on 22nd October 2020, acknowledged and thanked the Federal Bureau of Investigations, the U.S. Postal Inspection Service, the Internal Revenue Service, and the North Carolina’s Medicaid Investigations Division for their dedication during the investigation of this case.

William Bozin and Michael Savage, U.S Assistant Attorneys of the U.S. Office of Attorney, Charlotte, are prosecuting the case.

People who conspire or mastermind Health Care Fraud conspiracies break the law. Masterminding or plotting to execute Health Care Fraud conspiracies is a serious criminal activity. Any person or medical practitioner who masterminds or schemes Health Care Fraud conspiracies is severely penalized or punished if found guilty and responsible for the criminal action. If charged for a mastermind or plotting a Health Fraud scheme, you must seek legal assistance or representation to pursue and protect your rights. If you receive the finest legal representation, advice, or assistance, you get positive results in your case. Hire us immediately if you want the most excellent legal representation, advice, or assistance to achieve positive results in your case. Health Care Fraud Group has a highly trained team of skilled criminal attorneys and health care fraud defense attorneys with excellent experience and matchless case win history. The team is highly conversant and understands the need to prove innocence after the indictment of any offense, like any of the crimes mentioned above. Call us now or anytime at 888-402-4054 for any legal assistance, advice, or representation you may need.

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