Cary man sentenced in elaborate multi-million-dollar Medicaid fraud scheme

A Cary man has been sentenced to more than 12 years in prison for defrauding the North Carolina Medicaid system of more than $7 million in an elaborate scheme, the Department of Justice announced.

Antonio Deon Fozard was sentenced Tuesday to 151 months in prison and three years of supervised release for conspiracy and health care fraud after being investigated by the FBI.

Fozard led a ring that made fraudulent claims to Medicaid for the reimbursement of behavioral health services from roughly 2012 to 2017, according to U.S. Attorney Michael Easley of the Eastern District of North Carolina.

Fozard pleaded guilty to the charges in February and has been ordered to pay $4,242,794 in criminal restitution to the North Carolina Fund for Medical Assistance.

“This defendant stole millions intended to provide healthcare to low-income families,” Easley said in a news release. “We will continue to investigate and prosecute those that mastermind these unconscionable schemes to misuse taxpayer funds meant to help those in need.”

Fozard owned and operated behavioral health companies in Raleigh, Durham, Garner, Sanford and Dunn.

Companies in the fraud scheme

The companies were part of a scheme to steal from Medicaid by billing for services that were not given. Those companies were Group Service, Group Service Solution, Zoofari Kids, and In Touch of Care.

Group Service employed co-conspirators Reginald Van Reese Jr. and Ruben Samuel Matos, who were part of a plot to gather personal identifying information, including Medicaid identification numbers, from Medicaid recipients in low-income neighborhoods.

The information was used to file false and fraudulent claims that Group Service submitted to Medicaid for reimbursement.

Co-conspirator Humberto “Ghost” Mercado was enlisted as a “note writer” by the company to create bogus documentation for a Medicaid audit.

When the company was audited, Fozard asked his “note writers” to fabricate medical records for the audit, which were later turned over to investigators.

Fozard also operated Zoofari Kids, a drop-in daycare in Garner that was funded by Medicaid fraud proceeds from Zoofari Kids’ mental health business.

Under Fozard, Zoofari filed thousands of false claims in the name of another provider whose information was used without his knowledge or consent, according to the DOJ. Zoofari obtained lists of stolen Medicaid beneficiary information to use in the fraudulent billings, and created fake medical records.

Co-conspirator Sharita Mathis Richardson also operated the daycare, whose Durham location had the same address as Group Service and purported to provide mental health treatment to Medicaid recipients, the release stated.

Group Service was eventually barred from billing Medicaid, according to the DOJ, and Fozard used another scheme through a different business, In Touch of Care.

An investigation found that In Touch of Care recycled Medicaid information from fraudulent billings submitted by Fozard’s other companies. Fozard also caused In Touch of Care to bill for services using the clinician information for a nurse practitioner who never performed the listed services.

Beyond defrauding Medicaid through his companies, Fozard worked with third party owners and operators of other companies to help them also bilk Medicaid for money.

Fozard conspired with brothers Jerry and Tony Taylor, the owners of Taylor Behavioral Health and Options Driven in the town of Monroe near Charlotte in this way, the release stated. Fozard sold them lists of stolen Medicaid beneficiary information for use in their own fraudulent billings.

Van Reese Jr., Matos, Richardson, and Jerry and Tony Taylor, the other involved co-conspirators in the fraud scheme, received separate prison sentences after pleading guilty to health care fraud in related cases filed in the Eastern District of North Carolina, the release stated.