An investigation led by the Nevada Attorney General’s Medicaid Fraud Control Unit (MFCU) has resulted in the conviction of eleven individuals involved in a scheme to defraud Medicaid through several behavioral health companies in Southern Nevada. The probe began in July 2017, focusing on Top Notch Behavioral Health and Shepherds Heart Services for submitting claims for unprovided services.
Attorney General Aaron D. Ford commented on the outcome: “I am proud of the work of the Medicaid Fraud Control Unit in working with other agencies to investigate this case and obtain convictions against these individuals to hold them accountable. My office will continue to hold people and companies that defraud the Medicaid system accountable and ensure Medicaid funds are available for those people that are in need of services.”
The investigation revealed connections among many of those convicted through a church operated at the time by Greg and Carol Kirby. With assistance from the Internal Revenue Service – Criminal Task Force (IRS-CTF), authorities found that providers were submitting false claims, listing practitioners who never worked for their companies, and billing for more than twenty-four hours of service per day. Some individuals also concealed criminal histories when enrolling as Medicaid providers.
Because there were allegations involving possible IRS fraud, prosecution was handled by the United States Attorney’s Office (USAO) for the District of Nevada. MFCU staff played a key role throughout, testifying before federal grand juries, assisting with fraud analysis, and providing expertise on behavioral health cases.
The investigation concluded with criminal convictions for eleven people tied to fraudulent operations within behavioral health companies. Court orders require approximately $5.5 million in restitution be paid back to Medicaid.
The MFCU is responsible for investigating financial fraud related to healthcare services or goods provided to Medicaid patients as well as instances of elder abuse or neglect. The unit receives most of its funding from a federal grant through the U.S. Department of Health and Human Services; state funds cover the remainder. Those convicted may be barred from future participation in Medicaid or Medicare programs.
Reports regarding suspected fraud or abuse can be made directly to MFCU at 702-486-3420 or 775-684-1100.
This case was investigated by the Attorney General’s Medicaid Fraud Control Unit.
