Healthcare Fraud: SHALONDA SUGGS Sentenced for Committing Health Care Fraud and Food Stamp Fraud

Healthcare Fraud
SHALONDA SUGGS Sentenced for Committing Health Care Fraud and Food Stamp Fraud

Oklahoma City Woman Pleads Guilty to Committing Health Care Fraud and Food Stamp Fraud

Oklahoma City, Oklahoma SHALONDA SUGGS, 36, of Oklahoma City, pled guilty last Thursday to health care fraud in connection with submitting false claims to Medicaid for behavioral health counseling services, announced Mark A. Yancey, Acting United States Attorney for the Western District of Oklahoma, and Scott Pruitt, Attorney General for the State of Oklahoma.  Suggs also pled guilty to stealing Supplemental Nutrition Assistance Program benefits (SNAP benefits, formerly known as food stamps), which she wrongfully received based on her false statements regarding her income.

On April 5, 2016, Suggs was indicted on sixteen counts of health care fraud and one count of theft of government funds.  The Indictment alleged that in July 2013, Suggs opened a behavioral health counseling agency called Focus Pointe Counseling, LLC.  It is alleged Suggs obtained a contract with the Oklahoma Health Care Authority (OHCA), which allowed Focus Pointe to receive reimbursement from Medicaid for providing behavioral health counseling services to Medicaid-eligible children.  It was alleged that Suggs then submitted Medicaid claims for behavioral health counseling services that were purportedly provided by four counselors supposedly employed by Focus Pointe.  It was alleged that the counselors were never actually employed by Focus Pointe and never provided any of the counseling services claimed by Focus Pointe.  It was alleged that the OHCA paid Focus Pointe for the false claims and that Suggs used the proceeds for her personal benefit.  It is further alleged that during the time period Suggs was fraudulently receiving funds from the OHCA, she was receiving SNAP benefits by making false statements to the Oklahoma Department of Human Services that she was unemployed and had a negligible source of income.

Last Thursday, Suggs admitted that on February 4, 2015, she used Focus Pointe Counseling to submit a claim to the OHCA using the name and Medicaid provider number of certain counselor for a behavioral counseling session that was supposedly provided to a Medicaid beneficiary on August 16, 2014.  Suggs admitted that the counselor was not in fact employed by Focus Pointe and that the counseling session was not actually provided.  She also admitted that from August 2014 through May 2015, she was receiving SNAP benefits that she obtained by making false statements about her lack of income.

As part of her plea, Suggs agreed to pay restitution to Medicaid in the amount of $204,334.24 and to the Supplemental Nutrition Assistance Program in the amount of  $4,959.00.

At sentencing, Suggs faces up to 10 years in prison, three years of supervised release, and a $250,000 fine on each count.  A sentencing date will be set by the court in approximately 90 days.  Reference is made to the Indictment and other public filings for further information.

Medicaid and SNAP are programs that are funded and administered jointly by the federal government and the State of Oklahoma. This case is the result of a cooperative federal and state investigation by the Federal Bureau of Investigation, the Oklahoma Attorney General’s Office, and the United States Department of Agriculture, Office of Inspector General.  It is being prosecuted by Assistant U.S. Attorney Amanda Maxfield Green and Oklahoma Assistant Attorney General Lory Dewey.

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