Over $12 Million Medicaid Fraud Scheme Leads to 14 Years of Prison for Substance Abuse … – OIG

NEW BERN, N.C. – A federal judge has handed down more than 14 years in federal prison to participants in a $12.7 Million Medicaid fraud scheme that paid more than $1 Million in kickbacks to drug addict patients. The case also resulted in the permanent closure of the fake substance abuse facility that carried out the crime, a $15 Million dollar fine, and the seizure of more than $6 Million in criminal proceeds, including cash, cars, and homes.

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This category refers to crimes committed by employees or insiders against their own organizations. It is often the most damaging because the perpetrator has authorized access to systems.

• Asset Misappropriation: The most common form, involving the theft of company resources. This ranges from simple “skimming” (taking cash before it’s recorded) to complex schemes involving the theft of inventory or intellectual property.
• Payroll Fraud: Employees may create “ghost employees” on the system, falsify their own timesheets to claim unworked overtime, or divert salary payments to their own accounts.
• Financial Statement Fraud: Management deliberately misrepresents the company’s financial health by inflating revenue or hiding liabilities to attract investors or meet performance bonuses.