Two NC women accused in defrauding Medicare and selling drugs | Crime

Two North Carolina women have been indicted by a federal grand jury and are facing charges of health care fraud conspiracy and drug charges.

According to the North Carolina Department of Justice, 42-year-old Karen Willis of Salisbury and 39-year-old Wendy Gibscon of Charlotte were each indicted on one count of health care fraud conspiracy, one count of paying and receiving illegal kickbacks, and one count of conspiracy to distribute controlled substances.

Wills, who also goes by Karen Boykin and Karen Jackson, faces an additional count of health care fraud conspiracy.

According the NCDOJ, Willis was part of a scheme from 2008 until January 2011 which defrauded Medicare and Medicaid by submitting false and fraudulent claims for medical services which were medically unnecessary, not provided, or both.  The indictment states that thes treatments included electromyography (“EMG”) and anorectal manometry (“AM”) procedures.

The scheme caused Medicare and Medicaid to pay over $400,000 in reimbursement payments for the fraudulent claims.

The indictment alleges that Wills became aware of an investigation into the alleged fraud scheme early on and attempted to cover the scheme by creating several false EMG and AM reports and placed those fictitious reports in patient files.

The indictment also alleges that from 2008 until 2009, Wills, Gibson, and others engaged in an illegal kickbacks scheme involving power wheelchairs.

According to information contained in the indictment, Wills used her position with her employer to submit fictitious referrals for patients to receive medically unnecessary power wheelchairs from Gibson’s employer. In some instances, Wills forged a physician’s signature on required qualification documents, while Gibson tracked and directed payment for those referrals.

The indictment also alleges that the defendants and others attempted to conceal the illegal kickback payments by falsely representing on invoices and checks that the payments were for nursing and billing services. This scheme resulted in payments for the medically unnecessary equipment from Medicare and Medicaid in excess of $300,000.

Wills and Gibson are also accused of conspiring to distribute controlled substances, saying Wills forged a physician’s signature on prescription pads she misappropriated from her employer, and issued fraudulent prescriptions in Gibson’s name. The prescriptions were written for controlled substances including oxycodone and hydrocodone / acetaminophen pills.

According to the indictment, Gibson then used her health insurance prescription benefit program to pay for the fraudulent prescriptions resulting in payments of over $30,000 for these fraudulent prescriptions. Wills and Gibson obtained and illegally distributed approximately 3,000 oxycodone pills, and approximately 5,000 hydrocodone / acetaminophen pills.

Gibson was arrested Wednesday on the indictment and is currently held in local federal custody.

Wills was arrested yesterday in Rowan County on unrelated charges and is currently detained in Rowan County.

If convicted, Gibson and Wills face a maximum statutory sentence of ten years in prison on the healthcare fraud conspiracy and a $250,000 fine; five years in prison and a $25,000 fine for the illegal kickbacks charge; and ten years in prison and a $1 million fine for the conspiracy to distribute controlled substances. Wills also faces a penalty of 10 years of imprisonment and a $250,000 fine for the additional charge of healthcare fraud conspiracy.