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Policy: Entitlements

Feds nail N.C., Tenn. women in Medicaid fraud cases

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Watchdog Blog,Health Care,Medicare and Medicaid,Corruption,Entitlements,Kelly Cohen,Waste and Fraud

What will $6.1 million get you today? For one North Carolina woman, it gets her 72 months in prison and two years court supervision.

Linda Smoot Radeker, 72, of Shelby, N.C., a mental health counselor, oversaw a scheme that defrauded Medicaid of about $6.1 million, the Department of Justice announced Thursday after her sentencing.

Radeker pleaded guilty in September 2012 to one count of health care fraud conspiracy and two counts of money laundering. As a licensed professional counselor, she "falsely claimed in billings submitted to Medicaid that she was the attending clinician for services provided to Medicaid recipients." The services supposedly done between 2008 and 2011 never actually happened, according to DOJ.

She also had a network of co-conspirators in nearby counties to whom she "rented out" her Medicaid provider number. In turn, she kept a percentage of reimbursements -- in some cases up to 50 percent -- of everything her co-conspirators bilked from the government. The co-conspirators used claims to Medicaid for children's after school programs.

Court documents show she used the money to buy two new cars, as well as a recreational vehicle and at least $500,000 in jewelry. Radeker will have to repay Medicaid $6,156,674.68.

"This is a very serious matter because health care fraud damages everyone," said Jeannine A. Hammett, Special Agent in Charge, IRS-Criminal Investigation. "Ms. Radeker received money she was not entitled to and she created false documents to hide the true nature of the funds."

Mechell D. Toles, 44, of Collierville, Tenn., was also sentenced on Tuesday after pleading guilty to one count of health care fraud. Toles "brazenly helped herself to more than $600,000 of taxpayer monies," said U.S. Attorney Edward L. Stanton III, while "serving in a position of trust and being paid to help at-risk children."

Toles -- who has a Ph.D. from Walden University -- will serve three years in prison for falsely billing Medicaid for counseling sessions "on dates before patients had been referred to her" and "on dozens of dates after she had discharged payments." In total, TennCare, Tennessee's Medicaid program, paid her $602,769.42.

She admitted she had no particular need for the money, all of which she spent. Despite saying she knew what she was doing was wrong, she did it anyway because it was "easy to do," according to officials. In addition to three years in prison, she will be under three years of supervised release and has to pay back all of the money.

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Kelly Cohen

Staff Writer
The Washington Examiner