A Clayton, North Carolina man, Luis Angel Lozada, was sentenced to 70 months in prison and three years of supervised release for conspiracy to commit healthcare fraud. As part of sentencing, Lozada was also ordered to pay $1,130,137 in criminal restitution to the North Carolina Fund for Medical Assistance. According to court documents and other information presented in court, between 2016 and 2020, Lozada conspired with multiple individuals to defraud the North Carolina Medicaid system by submitting over $1 million in false and fraudulent claims for the reimbursement of behavioral health services. In March 2016, Lozada formed a behavioral health business in North Carolina known as Cornerstone Family Services Group. Cornerstone was headquartered in Zebulon initially and later opened offices elsewhere in the district.
Cornerstone submitted high-volume Medicaid claims for services that were never rendered; the false claims relied on stolen beneficiary and clinician information that was incorporated into the fraudulent billings. Between 2016 and 2017, for example, Lozada partnered with co-conspirators Reginald Van Reese, Jr., and Ruben Samuel Matos to source and integrate the stolen Medicaid beneficiary data into Cornerstone’s billings. The beneficiary information, in turn, was used to back-bill Medicaid for the maximum number of units allowed, notwithstanding the fact that the beneficiary had never been treated by Cornerstone. Another co-conspirator, Humberto Mercado, was recruited to fabricate treatment records and began to do so before the first billings were submitted to Medicaid.
