North Carolina woman defrauds state Medicaid program of more than $55K

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Published Friday, September 11, 2020
by Nyamekye Daniel | The Center Square

(The Center Square) - A Raleigh woman has been sentenced to six to 17 months in prison and two years probation after officials said she stole more than $55,000 from North Carolina's Medicaid program.

According to Attorney General Josh Stein, Patricia Weatherspoon Mosden filed 20 false medical claims under her behavioral health services company, Kiawah Counseling, from Dec. 16, 2015, to Jan. 11, 2017.

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"When health care providers cheat the Medicaid program, they're wasting taxpayer resources and making it harder for those who need care to get it," Stein said. "My office will hold accountable those businesses and people who commit fraud and break the law."

Mosden submitted the claims to Eastpointe, a managed care organization that receives Medicaid funds for behavioral health services, for care her company never provided to Medicaid recipients. Eastpointe paid Mosden $55,703 for the services.

During the investigation, Mosden also produced fake medical records and service notes to the attorney general's Medicaid Investigations Division.

Mosden pleaded guilty to fraud by a medical assistance provider and obtaining property by false pretenses in Robeson County Superior Court. She also will have to pay the money back to Eastpointe.

The Medicaid Investigations Division has recovered more than $850 million in restitution and penalties from cases of fraud and abuse by health care companies and providers and patient abuse and neglect in facilities that receive Medicaid funding.

The Medicaid Investigations Division received 75 percent of its funding - or $6 million - from the U.S. Department of Health and Human Services in fiscal year 2020 and 25 percent - or $2.05 million - from the state.

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