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North Carolina Man Faces Up to 15 Years for Medicaid Fraud

A Monroe, North Carolina man pleaded guilty to Medicaid fraud on June 20, and now faces up to 15 years in prison. Jerry Taylor pleaded guilty to healthcare fraud and tax evasion. He admitted conspiring with healthcare providers over a two-year period and submitting Medicaid claims for children who were not treated by these providers. 

North Carolina Man Faces Up to 15 Years for Medicaid Fraud

Taylor conspired with Devon Rambert-Hairston,  a Monroe nurse practitioner, who pleaded guilty in April to money laundering, as well as collecting “thousands of dollars” in services she did not render. A nurse at Taylor’s behavioral health company, where Rambert-Hairston worked,  had claimed she met with 50 patients for 50 minutes a day – just do the math to determine the absurdity of the claim. 

In her plea agreement, Rambert-Hairston admitted she knew the funds were not derived from legitimate services and that she knew the services were not provided.  

Fewer Than Average Patients

As a nurse practitioner, Rambert-Hairston could perform many of the same services as a physician, including diagnosing illnesses and prescribing medication. While she certainly appeared busy according to her claims, her 2015 Medicare reimbursements were well below average. 

That year, she reported only 54 Medicare patients, ranking her 1058th out of 1,394 providers in North Carolina with this specialty. There were only 120 services performed on these patients, ranking her 1030th out of 1,394 providers in North Carolina with this specialty. The total number of services she provided patients was approximately half the number of the average provider with her specialty. 

A New Position 

In July 2015, Rambert-Hairston became the medical director of Taylor Behavioral Health Center (TBHC). Between September 2016, and February 2017, Taylor and his business submitted over $1.3 million in fraudulent Medicaid claims using Rambert-Hairston’s National Provider Identification Standard number as both the rendering and billing provider. She funneled $800,000 of the stolen funds to her own account, then send the remainder on to Taylor and other conspirators. 

Durham Woman Sentenced to 46 Months 

In another recent North Carolina Medicaid fraud case, a Durham woman was sentenced in February to serve 46 months in prison for her role in a $900,000 scheme. She must also pay more than $500,000 in restitution and forfeit several pieces of real estate to North Carolina Medicaid. Co-conspirator Christopher Brown was previously sentenced to serve 40 months in prison. 

Tamara McCaffity, 57, operated Dreamworks II and Prominence Consulting and Therapeutic Services, both supposedly mental health healthcare providers. In reality, there were no patients, there were no healthcare providers, and there was no actual location for either business, as both named empty offices as the site of their clinic. Again, Medicaid submissions were made by “clinicians” who saw more than 24 patients for one-hour sessions in a day. 

McCaffity also pleaded guilty to using stolen Medicaid beneficiary identification. 

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