BH fraud update: Counselor receives prison sentence for defrauding Medicaid of $6.1 million

A mental health counselor who admitted overseeing a health care scheme that defrauded Medicaid of at least $6.1 million for sham mental and behavioral health services was sentenced to 72 months in prison in August, announced Anne M. Tompkins, U.S. Attorney for the Western District of North Carolina. Linda Smoot Radeker, 72, of Shelby, N.C. was also sentenced to serve two years under court supervision and to pay $6,156,674.68 as restitution to Medicaid.

In September 2012, Radeker pleaded guilty to one count of health care fraud conspiracy and two counts of money laundering. In her plea agreement filed with the court, Radeker admitted that from 2008 to 2011 she obtained at least $6.1 million in fraudulent reimbursement payments from false claims submitted to Medicaid. According to filed court documents and today’s sentencing hearing, Radeker, a licensed professional counselor enrolled with North Carolina Medicaid, falsely claimed in billings submitted to Medicaid that she was the attending clinician for services provided to Medicaid recipients, when no such services were provided. Court records show that Radeker “rented out” her Medicaid provider number to a network of co-conspirators operating in Gaston and Cleveland Counties and elsewhere and, in return, kept a percentage of the fraudulent Medicaid reimbursements, sometimes as much as 50%.

Court records show that the co-conspirators used on the fraudulent claims primarily the Medicaid numbers of children whose parents thought were being enrolled in after school programs located in Shelby, Kings Mountain and Bessemer City, N.C. These after school programs were, in fact, owned and operated by Radeker’s co-conspirators.

According to court documents, Radeker made several large purchases using criminal proceeds including $21,500 to purchase a 2010 Ford Ranger and $44,440 to purchase a 2010 Lincoln MKS SUV. Radeker also used Medicaid money to purchase a recreational vehicle (RV) and at least $500,000 in jewelry.

In making the announcement, U.S. Attorney Tompkins stated, “Health care fraud harms all of us – government programs, private insurers, health care providers and individual patients. We remain committed to finding and prosecuting those who steal from important health care programs and putting a stop to the egregious assault of precious health care resources.”

North Carolina Attorney General Roy Cooper said, “This type of fraud hurts patients who really need care, wastes taxpayers’ money, and drives up health care costs for all of us. Our investigators and attorneys will continue to work with their federal partners to find and root out Medicaid cheaters.”

In sentencing the defendant, U.S. Chief District Judge Frank D. Whitney noted that “health care costs have been skyrocketing” and that “legitimate providers like [Radeker] . . . take scarce resources and stretch them even further” through theft and fraud. Judge Whitney observed that this was a “glaring example of health care fraud” where Radeker “personally pocketed in excess of $3 million.” In announcing the six year sentence, Judge Whitney stated that we have to make it clear that we trust health providers and that the trust placed on the individual is critical. Radeker breached that trust and the message has to be sent to others.

Radeker will be ordered to report to the Federal Bureau of Prisons upon designation of a federal facility. All federal sentences are served without the possibility of parole.

The investigation into Radeker was handled by the FBI, MID, IRS, and HHS-OIG. Special Assistance to the Task Force was provided by the North Carolina Division of Medical Assistance, Program Integrity Section. The prosecution was handled by Assistant U.S. Attorneys Kelli Ferry and Jenny Grus Sugar of the U.S. Attorney’s Office in Charlotte.