A second healthcare exec pleads guilty to Medicare fraud | Eastern North Carolina Now | A second Raleigh healthcare company executive has pled guilty to defrauding the Medicare system for millions of dollars.

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    Publisher's Note: This post appears here courtesy of the Carolina Journal. The author of this post is CJ Staff.

    A second Raleigh healthcare company executive has pled guilty to defrauding the Medicare system for millions of dollars. According to a press release from the U.S. Attorney's office for the Eastern District of North Carolina, Kayla Sloan, 28, falsified physician orders on behalf of two companies that billed Medicare $50 million between 2014 and 2021 for durable medical equipment, such as back, shoulder, knee and wrist braces.

    According to the Department of Justice news release, the evidence dates as far back as 2014 and and recently as 2021, showing that in many instances CRP and Blue File billed Medicare without supporting physician orders and without shipping the products. The companies involved were Carolina Rehab Products, Inc. (CRP), and Blue File DMC, LLC.

    Sloan was vice president of operations for the companies, and Tanya Parrish Grant, 51, of Raleigh, was the CEO. Grant pled guilty to healthcare fraud in July of 2022 for her role. Investigators say Medicare paid Grant more than $17 million over the eight years, which they say she used to purchase a home near Cameron Village in Raleigh, a townhome in Ft. Lauderdale, a Porche, several Land Rovers, and more than a million in cash and investments. Those assets were seized by the government.

    Investigators found that Grant was paying companies in India and Pakistan to provide her with lists of Medicare patients and their contact information. The lists came from call centers overseas that contacted Medicare patients to inquire about their need for medical equipment. The investigation showed that Grant's companies would then bill Medicare for the medical equipment, even if was not delivered or was returned by the patient. More than 1,400 claims were filed in the names of some 422 deceased individuals. In one case, her company billed Medicare for more than $50,000 in DME claims and the physician who allegedly authorized the order was already deceased.

    The scheme apparently fell apart when, in October 2020, Cigna conducted an audit of claims submitted by CRP for reimbursement. According to the evidence presented in court, CRP did not have doctor's orders or medical records sufficient to justify the billing to Cigna. At the direction of Grant, Sloan prepared blank prescription templates to mimic the orders that should have been in the patient files.

    "Grant used the templates to forge and backdate the prescriptions to deceive auditors. Sloan the provided these documents to Cigna as though they were genuine and in existence prior to the audits," U.S. Attorney Michael Easley's office reported.

    Prosecutors say Sloan and Grant knowingly submitted forged documents to prevent Medicare auditors from discovering prior false billings and recouping money. Sloan faces up to five years in prison after U.S. District Judge Terrence W. Boyle accepted her guilty plea to Making/Using False Healthcare Writings and Documents and Aiding and Abetting. Grant faces a maximum of up to ten years in prison.
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