NC Medicaid paid out nearly $214,000 to business owner for made-up therapy, feds say
The North Carolina Medicaid program doled out close to $214,000 over nearly two years for made-up therapy treatments, according to federal prosecutors.
Now a business owner accused of profiting off the scheme is going to prison.
Pamela Grace Faulkner, 60, was sentenced Tuesday to three years in prison and ordered to pay $213,927 in restitution, the U.S. Attorney’s Office for the Eastern District of North Carolina said in a news release. She pleaded guilty to one count of conspiring to commit health care fraud in 2019.
A defense attorney representing Faulkner did not immediately respond to McClatchy News’ request for comment Tuesday.
Faulkner runs Skeen Services Inc., a registered Medicaid provider with offices in Greensboro, Greenville, Lumberton and Wilson in North Carolina, court filings show.
She is accused of partnering with 36-year-old Renee Christine Borunda to submit thousands of fraudulent Medicaid reimbursement claims on behalf of Skeen Services between 2013 and 2014. Borunda was sentenced in 2018 to serve three years in prison and pay close to $226,000 in restitution.
She has since asked for compassionate release, citing the COVID-19 pandemic, unsafe prison conditions and underlying health conditions, court documents show.
Skeen Services has been registered with the N.C. Secretary of State as a limited liability company since 2009. It has a principal address in Greensboro and previously went by the names Skeen Behavior Services and Skeen Personal Care Services. Faulkner is listed as the registered agent.
The business provides outpatient behavioral health services through Medicaid, a federal health care program that helps cover the cost of medical treatments for low-income families, seniors and people with disabilities.
Some of those services included therapy, psychiatric medication management and psychological testing, prosecutors said in court documents.
Borunda reportedly used the Medicaid provider number of another therapist unaffiliated with Skeen Services to submit fraudulent claims on behalf of clients at Skeen Services whose information she was given by Faulkner, court filings state.
In one exchange, prosecutors said, Faulkner sent Borunda an email with the names of six clients. A few minutes later, she sent another email saying “please tell me how much it is. I need at lease 10K. I need 3500 for you. got some major bills.”
When investigators interviewed 13 families whose names had been used without their knowledge, prosecutors said some claimed they never received outpatient behavioral health services. Others said they previously received treatment at Skeen Services — but not recently and not from the therapist whose claim number was used.
In total, Borunda is accused of submitting 4,588 fraudulent claims on behalf of 199 different people, netting Skeen Services a total of $213,927 from the North Carolina Division of Health Benefits, prosecutors said.
Faulkner doled out Borunda’s portion of the proceeds in 44 checks between May 2013 and July 2014 that totaled $144,000, court documents state.
