Medicaid fraud conviction will force $2 million payment, 3 1/2 years in prison
By Mitch Kokai, Carolina Journal
An Angier man faces 3 1/2 years in federal prison and restitution of nearly $2 million for his role in a Medicaid fraud scheme. Ruben Samuel Matos learned his sentence today, according to a release from the U.S. Attorney's Office in North Carolina's Eastern District.
Matos pleaded guilty in September 2020 to a charge of conspiracy to commit health care fraud. His sentence includes an order to pay $1,997,883 to the N.C. Fund for Medical Assistance.
"[B]etween 2014 and 2017, Matos conspired with multiple individuals and businesses to defraud the North Carolina Medicaid system by submitting over $3.6 million in false and fraudulent claims for the reimbursement of behavioral health services," according to the release.
Matos worked with Reginald Van Reese Jr. of Raleigh, who was convicted of conspiracy in a related case. "As part of the scheme, Matos and Reese canvassed low-income neighborhoods to identify eligible Medicaid recipients and collect their personal information, including Medicaid identification numbers," according to the release. "The beneficiary information was then sold and supplied to behavioral health business operators for the unlawful purpose of generating fraudulent claims for reimbursement of services that were never rendered."
Matos and Reese also worked with Antonio Deon Fozard of Durham. He "controlled multiple behavioral health entities, including Group Service and In Touch of Care."
"Fozard, Matos, and Reese defrauded the North Carolina Medicaid system by incorporating stolen Medicaid beneficiary and clinician data into false billings for these entities and enlisting 'note writers' to fabricate supporting medical documentation for use in the event of an audit," according to the release.
Matos and Reese also collaborated with Luis Angel Lozada of Clayton. He owned and operated Cornerstone Family Services Group, a "purported behavioral health business" in Zebulon. "According to the investigation, Cornerstone used stolen Medicaid beneficiary and clinician data to back-bill the Medicaid system and recruited note writers to prepare bogus medical records to substantiate the claims," the release reported.
Fozard and Losada are awaiting sentencing after pleading guilty to health care fraud charges.
