NC family scammed millions from SC Medicaid and those in need, prosecutor says
Four members of a North Carolina family are going to federal prison after pleading guilty to scamming millions from South Carolina Medicaid, the U.S. Attorney’s Office said Tuesday.
Tony Lee Covington, 50, his wife Priscilla Covington, 51, and his sisters Vanessa McPhaul, 56, and Mary Moses Covington, 51, were sentenced for conspiracy to commit wire fraud, acting U.S. Attorney Rhett DeHart said in a news release.
As a part of their scheme, the Raeford, North Carolina residents founded two health care companies which they used to defraud South Carolina Medicaid out of more than $3.6 million, according to the release.
“Stealing from agencies that serve those in distress is shameful, and illegal,” DeHart said in the release.
The companies, Preferred Care Incorporated and Saving Grace Outreach, claimed to provide rehabilitative behavioral health services to disabled, low-income individuals in South Carolina through Medicaid. Instead, between 2014 and 2016, the companies billed South Carolina Medicaid millions for “crisis intervention,” a service offered to individuals experiencing extreme emotional distress like suicidal thoughts or mental breakdowns, the U.S. Attorney’s office said.
Despite the companies having less than 20 clients, they billed more in total for crisis intervention services than the entire South Carolina Department of Mental Health, DeHart said.
Clients told investigators while they received some services from the companies, they never received any crisis intervention, according to the release.
Evidence showed the services provided by the companies should have been billed at approximately $9 an hour, but by billing the services as crisis intervention, the companies were instead paid $67.88 per hour, the U.S. Attorney’s Office said.
Once the irregular billing was discovered, Medicaid instituted an audit of Preferred Care, according to the release. In spite of the audit, the family immediately started Saving Grace Outreach to continue the fraudulent billing, the U.S. Attorney’s Office said.
U.S. District Judge Mary Lewis sentenced Tony Covington to 51 months in federal prison, Priscilla Covington to 39 months in federal prison, Mary Covington Moses to 33 months in federal prison, and Vanessa Covington McPhaul to 33 months in federal prison, according to the release. There is no parole in the federal system.
Additionally all four were given a three-year term of court-ordered supervision and ordered to repay $3,647,094.83 in restitution to South Carolina Medicaid, the U.S. Attorney’s Office said.
“This Medicaid fraud scheme enabled providers to steal millions of dollars from taxpayers, which means there’s less money available for people who actually need medical care,” South Carolina Attorney General Alan Wilson said in the release.
The case was investigated by the U.S. Department of Health and Human Services and South Carolina Attorney General’s Office.
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This story was originally published November 9, 2021 at 11:36 AM with the headline "NC family scammed millions from SC Medicaid and those in need, prosecutor says."
