From The Tribune staff reports
BIRMINGHAM, Ala. – U.S. Attorney Prim Escalona, Alabama Attorney General Steve Marshall, and U.S. Department of Health and Human Services Office of Inspector General Special Agent in Charge Derrick Jackson, announced the sentencing today of Sharon D. Waltz, 51, for defrauding the Alabama Medicaid Agency of at least $1.5 million. Waltz operated Capstone Medical Resources, a provider of counseling services with its primary office in Birmingham.
U.S. District Court Judge R. David Proctor sentenced Waltz to three years’ imprisonment and ordered her to repay $1.5 million to the Alabama Medicaid Agency. Waltz pleaded guilty last year to one count of conspiracy to commit healthcare fraud for filing false claims for individual and group counseling services for at-risk youth.
An investigation was initiated by the Program Integrity Division of the Alabama Medicaid Agency after an audit showed that billings submitted by Capstone for counseling services had increased from $99,000 in 2015 to more than $2 million in 2017. The Program Integrity Division referred its findings to the Attorney General’s Medicaid Fraud Control Unit after Waltz submitted falsified records during the Program Integrity Audit.
A subsequent investigation was conducted by the Medicaid Fraud Control Unit and the Office of Investigations of the U.S. Department of Health and Human Services Office of Inspector General. This investigation determined that Waltz billed for services that were never provided, and that most claims submitted by Capstone during 2016 through 2018 were fraudulent.
“Waltz’s actions demonstrated reckless disregard for at-risk youth, and she will now face the consequences of those actions,” U.S. Attorney Prim F. Escalona said. “Today’s sentence demonstrates our commitment to insuring that at-risk youth receive needed Medicaid services.”
Attorney General Marshall said, “It is appropriate that this defendant face stern consequences for engaging in an illegal and immoral scheme to profit at the expense of children in need by claiming payment for services that were never provided. As Attorney General, I stand committed with the U.S. Attorney and the Department of Health and Human Services to punish those who plunder the public treasury and betray the at-risk youth they were entrusted to serve.”
“Today’s sentencing should serve as a reminder to everyone who transacts business with federal health care programs, including Medicaid, that those programs are protected by a dedicated team of investigators and prosecutors,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “We will not tolerate fraudulent actors who illegally enrich themselves at the expense of patients and the American people.”
The U.S. Department of Health and Human Services OIG, the Alabama Attorney General’s Medicaid Fraud Control Unit, and the Program Integrity Division of the Alabama Medicaid Agency investigated the case. Assistant U.S. Attorney J.B. Ward and Assistant Attorney General Bruce Lieberman, working as a Special Assistant U.S. Attorney, prosecuted.