RALEIGH, N.C. (NCN News) – North Carolina and federal prosecuters have taken a big bite out of Medicaid fraud with a settlement announced Wednesday (May 6).
In a press release, Attorney General Jeff Jackson and the United States Attorney’s Office for the Middle District of North Carolina say they have reached $584,143 settlement with Crossroads Treatment Center of Greensboro, P.C. (Crossroads) to settle allegations that Crossroads submitted false claims to the Medicaid program. Half of the funds will go back to the Medicaid program and half will go to fund North Carolina public schools.
“This is the best-case scenario for addressing fraud and waste in the Medicaid program,” said Attorney General Jeff Jackson. “A managed care organization flagged something that was out of pattern, we worked with our federal partners and the U.S. Attorney’s Office for the Middle District to investigate, and the facility cooperated with us to resolve the issues and repay the Medicaid program. We’re going to protect every single dollar taxpayer dollar to ensure it goes to taxpayer healthcare.”
“False claims undermine the integrity of the Medicaid program and waste valuable taxpayer dollars,” said First Assistant United States Attorney Mike DeFranco. “It is the mission of this to identify and hold accountable providers that seek to enrich themselves and defraud taxpayers by submitting such claims. Together with our partners at the North Carolina Attorney General’s Office, we will continue to identify fraud and pursue justice on behalf of Medicaid.”
Crossroads treated patients with substance use disorders. This settlement resolves allegations that between 2019 and 2023, Crossroads submitted claims for urinary drug testing to the North Carolina Medicaid program without giving physicians the option to order a lower level of urine drug testing, resulting in more complex testing than was medically necessary. Crossroads voluntarily closed its clinical laboratory in 2024.
The irregular billing was first identified by Trillium Health Resources (previously the Sandhills Center), a managed care organization. Most North Carolinians who receive Medicaid coverage do so through a managed care organization. Trillium referred this matter to the N.C. Division of Health Benefits’ Office of Compliance and Program Integrity, which referred it to NCDOJ.
The federal and North Carolina False Claims Acts authorize the governments to recover triple the money falsely obtained, plus substantial civil penalties for each false claim submitted. It should be noted that the civil claims asserted in this matter are allegations only, and that there has been no judicial determination or admission of liability.
NCDOJ’s Medicaid Investigations Division and the United States Attorney’s Office for the Middle District of North Carolina investigated this case along with the Office of Inspector General of the U.S. Department of Health and Human Services, the N.C. Division of Health Benefits Office of Compliance and Program Integrity and Clinical Policy Section, and Trillium Health Resources’ Special Investigations Unit.
The Attorney General’s MID investigates fraud and abuse by health care companies and providers, as well as patient abuse and neglect in facilities that are funded by Medicaid. MID is North Carolina’s Medicaid Fraud Control Unit, the unit required by federal law to ensure taxpayer dollars in the Medicaid program go to fund patient care, not fraud. MID investigates and prosecutes Medicaid provider fraud and patient abuse. Medicaid is a joint federal-state program that helps provide medical care for people with limited income. To date, the MID has recovered more than $1.2 billion in restitution and penalties for North Carolina. MID has won more than $41 million in civil penalties since 2012 that go to fund North Carolina’s public schools.