A $14.6 billion web of deceit that stretched across the country has prompted a massive federal crackdown in the U.S. health care system. More than 300 people are facing charges nationwide in what the Justice Department calls the largest health care fraud takedown in American history.
In North and South Carolina, prosecutors say scammers siphoned off over $20 million in taxpayer funds by filing fraudulent claims, targeting the most vulnerable, including severely disabled children.
“Republican and Democrat, we’re all here with one goal and that is to eradicate health care fraud,” said U.S. Attorney Russ Ferguson, according to WCNC.
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Fake clinics, stolen IDs and sham services
The Carolina cases are part of what officials are calling “Operation Border War,” named after the investigation into a network of fake companies near the border between North and South Carolina operated with the alleged goal of defrauding Medicaid.
A multi-state probe uncovered two major schemes, both operating out of Charlotte and crossing state lines. In the first case, authorities say Donald Saunders and seven co-conspirators allegedly stole $21 million from South Carolina’s Medicaid program by filing false claims using stolen patient information of severely disabled children.
But these kids never received care.
“The majority, nearly all of these were severely disabled children,” said South Carolina Attorney General Alan Wilson. “Children who were quadriplegic or nonverbal or autistic, billing for services that these minor, severely disabled children never received.”
Investigators say the suspects made up fake medical records, billed for nonexistent therapies and cashed in to the tune of $21 million.
In a separate North Carolina scheme, Crystal Jackson from Charlotte allegedly raked in nearly $2 million by billing Medicaid for services to patients who were either deceased or in jail.
“She held herself out as a licensed provider of health care. She was not,” said North Carolina Attorney General Jeff Jackson. “She provided services to folks who were incarcerated or deceased, or at least claimed to.”
The Carolinas’ cases are just a part of the nationwide sweep, with 324 defendants, nearly 100 licensed medical professionals and 25 doctors now facing federal and state charges.
While the Justice Department says $14.6 billion in fraudulent claims were submitted nationwide, only a fraction — about $2.9 billion — was actually paid out. In the Carolinas alone, scammers are accused of successfully stealing more than $20 million from Medicaid.
Attorney General Alan Wilson says the crackdown in the Carolinas and nationwide sends a clear message: “If you continue … defrauding the Medicaid system, you are going down.”
Authorities say the investigation is far from over, and more arrests could be coming. Both state attorneys general are urging whistleblowers and concerned citizens to step forward.
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How to spot and fight health care fraud
Health care fraud isn’t just a government problem; it drains taxpayer dollars, raises insurance costs and undermines care for those who truly need it. Here’s what to look for and how to stop it.
- Review medical bills and statements: Always check Explanation of Benefits (EOB) statements carefully. Keep your eyes peeled for services you didn’t receive or duplicate charges.
- Protect your personal information: Don’t share your Medicaid or Medicare numbers except with trusted medical providers. Fraudsters often steal patient IDs to file fake claims.
- Ask questions: If a provider recommends expensive tests or treatments, ask why. Get second opinions if something feels off.
- Report anything suspicious: If you suspect fraud, like billing for services never received or fake providers, contact your state Medicaid fraud control unit or the U.S. Department of Health and Human Services’ Office of Inspector General.
- Document everything: Keep copies of all medical records, bills and communications with health care providers.
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This article provides information only and should not be construed as advice. It is provided without warranty of any kind.