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North Carolina man sentenced to prison, ordered to pay nearly $2 million in restitution for conspiring to defraud Medicaid

Ruben Samuel Matos, of Angier, was sentenced Wednesday, August 18, 2021 to 42 months in prison and three years of supervised release for conspiracy to commit health care fraud, according to a press release from the U.S. Attorney’s Office, Eastern District of North Carolina. On September 18, 2020, Matos pleaded guilty to the charge. As part of sentencing, Matos was also ordered to pay $1,997,883 in criminal restitution to the North Carolina Fund for Medical Assistance.

According to court documents and other information presented in court, between 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. Medicaid is a federally funded health care benefit program that helps pay for medical-related services for low-income individuals and their families. In North Carolina, Medicaid is administered by the North Carolina Department of Health and Human Services, Division of Health Benefits.

According to the U.S. Attorney’s Office, Matos initially partnered with Reginald Van Reese Jr., a Raleigh resident who was previously 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,” stated 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 worked closely with co-conspirator Antonio Deon Fozard, a Durham resident who controlled multiple behavioral health entities, including Group Service and In Touch of Care, according to the release. “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,” stated the release.

“In furtherance of a similar Medicaid fraud scheme, Matos and Reese later partnered with Luis Angel Lozada, a Clayton, NC resident who owned and operated Cornerstone Family Services Group, a purported behavioral health business in Zebulon, NC,” stated the release. “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.”

Antonio Fozard and Luis Lozada pleaded guilty to health care fraud charges in the U.S. District Court for the Eastern District of North Carolina and are currently awaiting sentencing.

G. Norman Acker III, acting U.S. Attorney for the Eastern District of North Carolina, made the announcement after sentencing by U.S. District Judge Louise W. Flanagan. The Federal Bureau of Investigation and the North Carolina Medicaid Investigations Division investigated the case and Assistant U.S. Attorney Adam F. Hulbig prosecuted.

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