Summer Matheson, Terrence Ewing, Richard Grundy, Medicaid Fraud, Illinois 2018

Medicaid Scammers Sentenced to Prison

CHICAGO — Summer Matheson, 46, of Chicago, and Terrence Ewing, 62, of Chicago, the co-managers of Laynie Foundation Inc., were sentenced to federal prison terms for bilking Illinois Medicaid out of approximately $2.5 million through a fraudulent billing scheme. Matheson’s accomplice, Richard Grundy, 39, of Chicago, also received a prison sentence.

Between 2011 and 2018, Matheson, Ewing, and Grundy, along with other foundation employees, fraudulently billed Illinois Medicaid for more mental health counseling services than the foundation actually provided. They also used the Matteson, Ill.-based foundation to seek payment from Illinois Medicaid for non-reimbursable activities, such as internal case reviews, staff training, clinical supervision, and recordkeeping.

Matheson attempted to cover up the fraud by directing foundation personnel to backdate and falsify patient records to make it appear that a licensed practitioner had reviewed and approved certain mental health services, when, in fact, Matheson knew that a practitioner had not reviewed and approved those services.

As a result of the fraud, Matheson, Ewing, and Grundy fraudulently obtained approximately $2.5 million from Illinois Medicaid and managed-care organizations used by Illinois Medicaid.

Matheson, Ewing, and Grundy each pleaded guilty last year to a federal health care fraud charge. U.S. District Judge John Robert Blakey on Thursday sentenced Matheson to six years in federal prison, Ewing to four and a half years, and Grundy to three years and a month.

The sentences were announced by Morris Pasqual, Acting United States Attorney for the Northern District of Illinois, Mario Pinto, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General, and Douglas S. DePodesta, Special Agent-in-Charge of the Chicago Field Office of the FBI.

Valuable assistance in the investigation was provided by the Illinois Attorney General’s Office, Illinois State Police, and Illinois Department of Healthcare and Family Services. The government was represented by Assistant U.S. Attorneys Prashant Kolluri and Charles W. Mulaney.

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