A Charlotte behavioral health services provider, Ashley Nicole Cross, has been indicted on federal charges for defrauding the South Carolina Medicaid Program and falsely obtaining COVID-19 relief funds. The 16-count federal indictment alleges that Cross carried out an extensive healthcare fraud scheme, submitting fraudulent reimbursement claims for rehabilitative behavioral health services that were never provided. Cross allegedly paid for the personal identifying information of qualified Medicaid beneficiaries, using it to file fraudulent claims totaling at least $400,000. Additionally, Cross executed a scheme to obtain fraudulent Paycheck Protection Program loans, resulting in over $120,000 in COVID-19 relief funds. If convicted, Cross faces significant prison time for multiple charges, including healthcare fraud, money laundering, and wire fraud conspiracy. The FBI investigated the case with the assistance of the South Carolina Attorney General’s Office, Medicaid Fraud Investigations.
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Indictment of Charlotte Behavioral Health Services Provider
Charges and Allegations
A Charlotte behavioral health services provider, Ashley Nicole Cross, has been indicted on federal charges for allegedly defrauding the South Carolina Medicaid Program and falsely obtaining COVID-19 relief funds. The 16-count federal indictment includes charges of healthcare fraud, making false writings and statements relating to a healthcare matter, promotion money laundering, wire fraud, wire fraud conspiracy, and wire fraud affecting a financial institution.
Healthcare Fraud Scheme
The federal indictment alleges that Cross owned and operated Odyssey Health Group (OHG), a Charlotte-based company that provided outpatient behavioral health services to eligible Medicaid beneficiaries in South Carolina. From 2016 to 2021, Cross carried out an extensive healthcare fraud scheme by submitting fraudulent reimbursement claims to SC Medicaid and its contracted managed care organizations for rehabilitative behavioral health services that were never provided. Cross allegedly paid for the personal identifying information (PII) of qualified SC Medicaid beneficiaries and used this information to file fraudulent reimbursement claims totaling at least $400,000. To make the fraudulent claims appear legitimate, Cross instructed OHG employees to create fictitious patient files and clinical service notes in the names of beneficiaries.
False Writings and False Statements Charges
In September 2019, Cross was informed of an audit into OHG’s claims. To cover up the fraud, Cross allegedly submitted fictitious patient medical records and made false statements to the auditor. These actions are charged as making false writings and false statements relating to a healthcare matter.
Promotion Money Laundering Charges
The indictment also alleges that Cross engaged in money laundering by using some of the fraudulent proceeds to promote the scheme. Cross allegedly paid for Medicaid beneficiary names and PII to further the fraudulent activities.
Wire Fraud Charges
Cross is also charged with wire fraud, as the indictment alleges that she used interstate wire communications to carry out the fraudulent scheme. Wire fraud carries a maximum statutory sentence of 20 years in prison per count.
Wire Fraud Conspiracy Charges
Additionally, Cross is charged with wire fraud conspiracy affecting a financial institution. This charge carries a maximum penalty of 30 years in prison.
Investigation and Prosecution
The federal investigation into this case was conducted by the Federal Bureau of Investigation (FBI), with substantial assistance from the South Carolina Attorney General’s Office, Medicaid Fraud Investigations. The case is being prosecuted by Assistant U.S. Attorney Michael E. Savage of the U.S. Attorney’s Office in Charlotte.
Possible Penalties
If convicted, Cross faces significant penalties for each charge. The healthcare fraud offense carries a maximum penalty of 10 years in prison for each count in the indictment. Making false writings and false statements relating to a healthcare matter carries a maximum prison sentence of five years. The promotion money laundering and wire fraud charges each carry a maximum statutory sentence of 20 years in prison per count. The charge of wire fraud conspiracy affecting a financial institution carries a maximum penalty of 30 years in prison.
Overview of the Healthcare Fraud Scheme
Cross, as the owner and operator of Odyssey Health Group (OHG), enrolled the company with SC Medicaid to provide outpatient behavioral health services to eligible Medicaid beneficiaries in South Carolina. However, between 2016 and 2021, Cross allegedly carried out a healthcare fraud scheme by submitting fraudulent reimbursement claims to SC Medicaid and its contracted managed care organizations. These claims were for rehabilitative behavioral health services that were never provided.
To execute the fraud, Cross paid for the personal identifying information (PII) of qualified SC Medicaid beneficiaries. She then used this information to file fraudulent reimbursement claims, totaling at least $400,000. In order to make these claims appear legitimate, Cross instructed OHG employees to create fictitious patient files and clinical service notes in the names of beneficiaries.
Cover-Up and Money Laundering
When Cross became aware of an audit into OHG’s claims in September 2019, she allegedly took steps to cover up the fraud. The indictment states that Cross submitted fictitious patient medical records and made false statements to the auditor. These actions were intended to conceal the fraudulent activities.
In addition to the cover-up, Cross engaged in money laundering by using some of the fraudulent proceeds to promote the scheme. She allegedly paid for Medicaid beneficiary names and PII to further the fraudulent activities.
Details of the COVID-19 Fraud Scheme
The indictment also includes charges related to a COVID-19 fraud scheme. From April 3, 2020, to May 14, 2022, Cross executed a scheme to obtain fraudulent Paycheck Protection Program (PPP) loans. These loans were obtained on behalf of OHG and Gucci International Inc., a purported event planning business owned by a co-conspirator.
To secure the PPP loans, Cross submitted loan applications and supporting documents that contained false statements. These false statements misrepresented OHG’s and Gucci’s payroll expenses, number of employees, and other relevant information. As a result of the fraudulent loan applications, Cross and her co-conspirator obtained more than $120,000 in COVID-19 relief funds.
It is important to note that the charges against Cross are allegations, and she is presumed innocent until proven guilty beyond reasonable doubt in a court of law.
Presumption of Innocence
As with any criminal case, it is essential to respect the defendant’s right to be presumed innocent until proven guilty beyond reasonable doubt in a court of law. Cross has the right to defend herself against the charges and present evidence in her defense. The initial appearance in federal court will provide an opportunity for Cross to respond to the charges.
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Potential Penalties and Charges
If found guilty, Cross faces maximum prison sentences for each charge. The healthcare fraud offense carries a maximum penalty of 10 years in prison for each count in the indictment. Making false writings and false statements relating to a healthcare matter carries a maximum prison sentence of five years. The promotion money laundering and wire fraud charges each carry a maximum statutory sentence of 20 years in prison per count. The charge of wire fraud conspiracy affecting a financial institution carries a maximum penalty of 30 years in prison.
Assistance and Partnership in the Investigation
The investigation into this case was a collaborative effort between the FBI and the South Carolina Attorney General’s Office, Medicaid Fraud Investigations. Their partnership and assistance in uncovering the alleged fraud were crucial in bringing forth the indictment against Ashley Nicole Cross.
The FBI’s involvement highlights the commitment of law enforcement agencies to combat healthcare fraud and protect the integrity of government programs. By working together, these agencies strive to hold individuals accountable for their actions and deter future fraudulent activities.
In conclusion, Ashley Nicole Cross, the owner and operator of Odyssey Health Group, now faces serious federal charges for her alleged involvement in healthcare fraud and COVID-19 relief fraud schemes. The indictment against Cross outlines the charges and allegations, as well as the potential penalties associated with each charge. The investigation and prosecution of this case are a testament to the efforts of law enforcement agencies to combat fraudulent activities within the healthcare industry.
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