Durham Woman gets Nearly Four Years in Federal Prison for Medicaid Scam | Eastern North Carolina Now

    Publisher's note: This post appears here courtesy of the Carolina Journal, and written by Dan Way, associate editor.

    A Durham woman is going to federal prison for bilking the Medicaid system out of more than $900,000, U.S. Attorney Robert Higdon announced on Friday.

    U.S. District Court Judge Louise Flanagan sentenced Tamara Perry McCaffity, 57, to 46 months in prison followed by three years of supervised release for filing false claims for reimbursement. She was ordered to make $523,783 in restitution, and surrender real estate properties on Empire Lakes Drive in Raleigh, Elmridge Court in Durham, and in Orlando, Florida.

    Criminal papers filed in July 2018 charged McCaffity with taking part in an elaborate conspiracy to commit health care fraud, Higdon said in a news release. She pleaded guilty in October.

    The Federal Bureau of Investigation and state agencies determined McCaffity operated two mental health businesses - Dreamworks II and Prominence Consulting & Therapeutic Services. Higdon cited the charging documents, statements made in open court, and other public information showing she conspired over a three-year period to commit fraudulent billings to Medicaid for mental health services that were never delivered.

    Dreamworks II submissions included claims that a clinician conducted one-hour counseling sessions for more than 24 clients in a single day. Both Dreamworks II and Prominence Consulting used stolen Medicaid beneficiary information and/or clinician information, according to Higdon.

    Prominence Consulting was a shell company registered to an empty office suite in Raleigh, but it submitted thousands of false claims seeking reimbursement for services purportedly rendered on behalf of Medicaid beneficiaries, Higdon said. No services were provided, and the Medicaid beneficiary and clinician information listed on the claims was obtained fraudulently.

    Protection of government programs designed to help the most vulnerable is a key priority of his office, Higdon said. Medicaid serves 2.1 million poor, elderly, disabled, pregnant women, and children in North Carolina.

    "When people defraud the Medicaid program, they're cheating taxpayers and taking away resources from people who need health care," said N.C. Attorney General Josh Stein.

    McCaffity's co-conspirators included Christopher Leon Brown, who was previously convicted and sentenced to 40 months in prison.