Angier Man Sentenced for Medicaid Fraud Scheme
A North Carolina resident has been sentenced to prison for his role in a Medicaid fraud scheme that netted over $3.6 million in false claims. Ruben Samuel Matos, a resident of Angier, North Carolina, was sentenced to 42 months in prison and three years of supervised release for conspiracy to commit health care fraud.
Matos, 42, pleaded guilty to the charge on September 18, 2020. As part of his sentencing, he was ordered to pay $1,997,883 in criminal restitution to the North Carolina Fund for Medical Assistance.
According to court documents, Matos conspired with multiple individuals and businesses to defraud the North Carolina Medicaid system between 2014 and 2017. The scheme involved submitting over $3.6 million in false and fraudulent claims for the reimbursement of behavioral health services.
Matos initially partnered with Reginald Van Reese, Jr., a Raleigh resident who was previously convicted of conspiracy in a related case. The two men canvassed low-income neighborhoods to identify eligible Medicaid recipients and collect their personal information, including Medicaid identification numbers.
The beneficiary information was then sold and supplied to behavioral health business operators for the unlawful purpose of generating fraudulent claims for reimbursement of services that were never rendered. Matos and Reese worked closely with co-conspirator Antonio Deon Fozard, a Durham resident who controlled multiple behavioral health entities.
Matos and Reese later partnered with Luis Angel Lozada, a Clayton resident who owned and operated Cornerstone Family Services Group, a purported behavioral health business in Zebulon. The investigation found that Cornerstone used stolen Medicaid beneficiary and clinician data to back-bill the Medicaid system and recruited note writers to prepare bogus medical records to substantiate the claims.
Antonio Fozard and Luis Lozada pleaded guilty to health care fraud charges and are currently awaiting sentencing. The case was investigated by the Federal Bureau of Investigation and the North Carolina Medicaid Investigations Division. Assistant U.S. Attorney Adam F. Hulbig prosecuted the case for the government.
Related court documents and information can be found on the website of the U.S. District Court for the Eastern District of North Carolina or on PACER by searching for Case No. 5:20-CR-307.
Key Facts
- State: North Carolina
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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