A Charlotte behavioral health services provider was convicted by a federal jury for defrauding the South Carolina Medicaid Program, falsely obtaining COVID-19 relief funds, and money laundering. Ashley Nicole Cross, 41, of Charlotte, was found guilty of healthcare fraud, making false statements and writings relating to a healthcare matter, promotional money laundering, wire fraud, and conspiracy. According to trial evidence—including 25 witnesses and over 600 documents—Cross owned and operated Odyssey Health Group (OHG), a Charlotte-based company, which was enrolled with SC Medicaid to provide outpatient behavioral health services to eligible Medicaid beneficiaries. Under SC Medicaid rules, beneficiaries are allowed to use providers within 25-miles of the South Carolina border, including Charlotte.
From 2016 to 2021, Cross’s company submitted fraudulent reimbursement claims to SC Medicaid and its contracted managed care organizations for rehabilitative behavioral health services that were never provided. To carry out the scheme, Cross used the personal identifying information (PII) of qualified SC Medicaid beneficiaries to file reimbursement claims totaling $1.3 million dollars. For some claims, Cross bought the PII of Medicaid beneficiaries she used to submit claims. To further the scheme and to give the appearance that OHG’s fraudulent claims were legitimate, Cross instructed OHG employees to create fake clinical service notes after she filed fraudulent claims in the names of Medicaid beneficiaries.
Trial evidence established that in September 2019, Cross was informed of audits of OHG’s Medicaid claims. To cover up the fraud, Cross submitted fictitious patient medical records and made false statements to auditors. Trial evidence further established that Cross engaged in money laundering and used some of the fraudulent proceeds to promote the scheme by paying for Medicaid beneficiary names and PII.
