U.S. Attorney Anne M. Tompkins has announced that Kristie Brake, 39, of Jonesville, and Kimberly Miles, 33, of Sparta, were sentenced June 15 in U.S. District Court in

Statesville to serve terms of imprisonment and ordered to pay more than $600,000 restitution in connection with federal charges of conspiracy and healthcare fraud.

According to a spokesperson with the U.S. District Court for the Western District of North Carolina Statesville Division, the two women were sentenced June 15 for defrauding Medicaid of $600,000.

A spokesperson with the court, who declined to be identified, in Statesville discussed the case last week.

“It had to do with Medicaid,” she said. “They got 46 months in prison and three years supervised release. They plead guilty to three counts, count 1, 8 and 9. There were 17 counts in the indictment. Some were dismissed.”

A grand jury had charged in a bill of indictment April 22, 2009 that around March 2003 to around January 2007 defendants Brake and Miles "defrauded Medicaid of approximately $600,000 by submitting more than 15,000 false and fraudulent claims for reimbursement."

"At times relevant to this indictment Heritage Home Care Inc. was a duly authorized N.C. corporation which Medicaid had approved to submit claims for reimbursement on behalf of Medicaid recipients receiving Personal Care Services (PCS)," said the spokesperson.

"PCS enable the elderly, people with disabilities and other individuals with chronic or temporary conditions to remain in their homes by assisting them with daily activities."

Those activities, according to the indictment, include "bathing, dressing, meal preparation and grocery shopping."

"In North Carolina PCS are reimbursable by Medicaid if certain eligibility requirements are met. Medicaid requires all authorized PCS providers to submit claims for only those PCS which have been rendered, to submit claims for only those PCS which had been authorized by a physician."

The indictment claimed Brake and Miles "also submitted false and fraudulent claims seeking reimbursement for services which were not eligible for reimbursement because a physician had not authorized the provision of PCS.

"Instead the defendants forged and caused to be forged a physician's signature on the prescription form ostensibly authorizing reimbursable PCS for that recipient."

The indictment charged that the two "submitted false and fraudulent claims seeking reimbursement for services which were not eligible for reimbursement because unindicted co-conspirator, a registered nurse, did not perform an initial assessment in the beneficiary's home."

According to the indictment, Brake and Miles also submitted false and fraudulent claims seeking reimbursement for services which were not eligible for reimbursement because the PCS was provided by an aide who was a member of the of the beneficiary's immediate family, "a practice which, as defendants well knew, was prohibited by state and federal law."

There were 17 counts of Health Care Fraud in the original indictment, and the counts took place in Alleghany County.

The two defendants were charged with devising a scheme, according to the indictment, to "defraud a healthcare benefit program."

Count two took place April 30, 2004, and count 17's claim was submitted Jan. 11, 2007.

Count one was conspiracy to defraud and obtain under false prestenses money or property owned by or under the control of Medicaid.

Counts eight and nine were the same charge, willfully submitting false and fraudulent claims for payment from Medicaid and aiding and abetting.

“They do have right much money to pay back. The amount of restitution that they have to pay back is $622,405. That is to be paid N.C. Medicaid,” said the spokesperson

“The Attorney General was involved. An agent testified who investigates fraud,” she said.

Melissa Rikard, assistant U.S. Attorney in Charlotte, prosecuted the case.

Suellen Pierce, public information office for the U.S. Attorney's Office Western District of North Carolina in Charlotte, reported on the case.

Judge Richard Voorhees was in charge of the proceedings in Statesville.

David Freeman of Winston-Salem represented Brake, and Stephen Slawinski with the federal public defender’s office in Charlotte represented Miles.

According to the U.S. attorneys, Brake and Miles, co-owners of Heritage Home Care, Inc. in Sparta located in Alleghany County, both previously entered pleas of guilty to

one count of conspiracy to commit healthcare fraud and two counts of healthcare fraud and

aiding and abetting.

"According to official court documents, Brake and Miles were co-owners of Heritage from

April 2003 until January 2007. As part of the healthcare fraud conspiracy to which

Brake and Miles pled guilty, Brake and Miles submitted false and fraudulent claims for payment for PCS which were either not provided to Medicaid beneficiaries or which were not eligible for reimbursement under state and federal law," attorneys said.

"Brake and Miles, for example, submitted false and fraudulent claims for reimbursement for services purportedly rendered after a beneficiary had died and for another beneficiary who had moved several hundred miles away. Brake and Miles altered time tickets completed by aides employed at Heritage to support false and fraudulent claims for reimbursement which had already been submitted to Medicaid."

Evidence in the proceedings showed the defendants forged physician signatures and submitted fraudulent initial assessments to support the provision of PCS, according to the U.S. Attorneys Office.

"The evidence also revealed that the defendants defrauded Medicaid by submitting fraudulent claims for reimbursement for PCS provided to relatives of aides working at Heritage, a violation of state and federal law," according to the office.

Brake and Miles submitted 15,833 false and fraudulent claims which defrauded

the Medicaid program of $622,405 they reported.

The case arose from a healthcare fraud investigation conducted by the Medicaid Investigations Unit of the North Carolina Department of Justice, according to Tompkins.

The two faced up to 10 years in prison for the conspirary count and a term of up to 10 years for each fraud count.