FWA- District of South Carolina | Greer Man Sentenced in Multimillion Dollar South Carolina Medicaid Scheme

MM Curator summary

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[MM Curator Summary]: Jonathan Sumter stole $1M using a fake behavioral health company that never actually had any clients or providers.



Clipped from: https://www.justice.gov/usao-sc/pr/greer-man-sentenced-multimillion-dollar-south-carolina-medicaid-scheme

Columbia, South Carolina – Jonathan W. Sumter, 51, of Greer, was sentenced to over 7 years in federal prison after pleading guilty in a case of theft of government funds for his scheme to defraud South Carolina Medicaid of over $1 million.

According to evidence presented to the Court, Sumter founded PHC Supportive Services as a company supposedly providing rehabilitative behavioral health services to disabled, low-income individuals in South Carolina through the Medicaid program. Instead, between 2015 and 2019, the company billed South Carolina Medicaid over one million dollars for services never performed.

The Government provided evidence that PHC never had any actual clients or service providers. Instead, Sumter repeatedly billed Medicaid by using the stolen National Provider Identifier (NPI) numbers of nine health care professionals to create fraudulent invoices to Medicaid. Sumter then used the stolen identities of 196 Medicaid members with severe mental and emotional health disorders without their knowledge or consent. Caregivers and clients contacted by investigators indicated that they had never received any services from Sumter or PHC. Additionally, the service providers Sumter used on his invoices indicated that they did not work for PHC and had not provided medical services for the company.

“Using stolen identifies of the most defenseless people to steal money from the hard-working people of South Carolina is unacceptable. We will continue to aggressively prosecute offenders who steal from programs designed to provide sorely needed care for our most vulnerable citizens,” said U.S. Attorney Adair Boroughs.

“This sentence warns bad actors in the behavioral healthcare field that South Carolina has citizens in need of these services; any fraudulent conduct that abuses these programs or prevents our citizens from receiving needed services will not be tolerated. Our office will continue to partner with the United States Attorney’s Office for the arrest and prosecution of those committing fraud against the Medicaid program. We thank our law enforcement partners at the United States Department of Health and Human Services’ Office of the Inspector General for their partnership during this investigation,”  Attorney General Alan Wilson said.

United States District Judge Donald C. Coggins sentenced Sumter to 92 months in prison. Sumter was also ordered to repay $1,055,373.66 in restitution to South Carolina Medicaid.

The case was investigated by the United States Department of Health and Human Services and the South Carolina Attorney General’s Office. It was prosecuted by Assistant United States Attorney T. DeWayne Pearson.