SC Man Pleads Guilty to Medicaid Fraud

Former Nursing Home Owner Pleads Guilty to Federal Charges of Medicaid Fraud

Fraud charges can have serious repercussions, especially in South Carolina
A South Carolina man who owned six nursing homes across the state has pled guilty to Medicaid fraud that landed him $1 million.

Richard C. Cooke, 53 years old, pleaded guilty on Wednesday, July 17th, to two indictments charged him with forgery, and four indictments on charging him with medical assistance provider fraud. He reportedly defrauded the South Carolina Medicaid program of $1 million.

The charges stem from fraudulent cost reports that Cooke submitted for reimbursement from the state’s Medicaid program.

Cooke was the owner and key manager of the Cooke Management Company Inc of Lake View, which operated six nursing homes located in Aiken, Bishopville, Fork, Florence, Kingstree and Fountain Inn.

South Carolina’s Medicaid regulations state that nursing homes must submit annual operational cost reports for their facility, and the program pays the facility based on the number of Medicaid residents. According to reports, Cooke’s nursing homes, between 2009 and 2011, submitted fraudulent operational cost reports, leading Medicaid to overpay the six facilities by $1,020,818.38, according to the state Attorney General’s Office.

Under the terms of his plea agreement, Cooke is required to plead guilty to his Medicaid fraud charges, pay back the $1 million he defrauded from the state’s Medicaid program, and he will be excluded for life from the Medicaid program. He will also cooperate with the Attorney General’s Office’s ongoing investigation.

Cooke’s forgery and Medicaid fraud charges led him to be sentenced to 16 years in prison total, which was suspended to 5 years’ probation, which includes house arrest and 500 hours of community service. He must also pay back the $1 million he fraudulently took from the Medicaid program.

Reportedly, he presented two $500,000 checks to go toward the restitution.

“Fraud committed against the Medicaid program deprives funds needed to pay for medical services, including nursing home care, for elderly citizens who can’t afford it otherwise,” state Attorney General Alan Wilson said in a statement. “As a result of this investigation and prosecution, the overpayments will be repaid, and the defendant will never again own or manage a nursing home facility.”

It Is Important to Report Medicaid Fraud

Medicare and Medicaid are government-sponsored health care programs that help the needy and the elderly cover health care costs associated with aging and disability. These programs are hugely important for people living on a fixed income, so it is incumbent upon doctors to honestly report costs both to patients and to the government.

Unfortunately, not all health care providers are honest in their assessments. Some health care providers defraud the government, in violation of the False Claims Act, by overbilling for services, double billing, or billing for services not provided. The False Claims Act imposes liability on persons or corporations that defraud the government – and this includes doctors, hospitals, and nursing homes.

The False Claims Act provides protection for those who report agencies or individuals who are defrauding the government. These lawsuits are called whistleblower, or qui tam, lawsuits.

Under the qui tam provision of the False Claims Act, the relator (plaintiff) files an action on behalf of the U.S. Government. The Act allows a wide variety of people and entities to file a qui tam action.

The whistleblower must have first-hand knowledge of the fraud. However, as an incentive for reporting the fraud, whistleblowers are eligible for 15-25% of any recovered damages.

The Strom Law Firm Protects Medicaid Fraud Whistleblowers in South Carolina

Common whistleblower actions include:

  • Health care fraud, including Medicare and Medicaid fraud,
  • defense contractor fraud, and
  • other kinds of fraud.

Qui tam lawsuits have been, and continue to be, a very effective and successful tool in combating government procurement and program fraud.

Bolstered by amendments passed by Congress in 1986, the law has armed private citizens who have independent and direct knowledge of fraud, with a weapon to prosecute government contractors and others who are defrauding the Government.

If you have first-hand knowledge of government fraud occurring at your place of employment or your doctor’s office, including Medicaid fraud, the attorneys at the Strom Law Firm can help protect your rights. In order to help the government provide the best possible services, Medicare and Medicaid fraud must be reported as soon as possible. The attorneys at the Strom Law Firm understand the complexity of qui tam and whistleblower suits, and we offer free, confidential consultations to discuss the facts of your case. Contact us today.803.252.4800



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