CHICAGO — The owners of a suburban Chicago youth counseling
center defrauded Illinois Medicaid out of approximately $4 million through a
fraudulent billing scheme, according to an indictment returned in federal
court.
From 2011 to 2018, SUMMER MATHESON and TERRENCE EWING,
co-owners of Laynie Foundation Inc., along with foundation employee RICHARD
GRUNDY, fraudulently billed Illinois Medicaid for more mental health counseling
services than the foundation actually provided, the indictment states. Matheson, Ewing and Grundy also used the
Matteson-based foundation to seek payment from Illinois Medicaid for
non-reimbursable activities, such as internal case reviews, staff training,
clinical supervision and recordkeeping, the indictment alleges. The indictment additionally accuses Matheson
of attempting to cover up the fraud by directing foundation personnel to
backdate and falsify patient records to make it appear that a licensed
practitioner had reviewed and approved certain mental health services, when, in
fact, Matheson knew that a practitioner had not reviewed and approved those
services. As a result of the fraud, Matheson,
Ewing and Grundy fraudulently obtained approximately $4 million from Illinois
Medicaid and managed-care organizations used by Illinois Medicaid, the
indictment states.
The indictment was returned Tuesday. It charges Matheson, 41, and Ewing, 57, both
of Dyer, Ind., with six counts of health care fraud. Matheson is also charged with one count of
obstruction of justice. Grundy, 34, of
Chicago, is charged with five counts of health care fraud. Arraignments in U.S. District Court in
Chicago have not yet been scheduled.
The indictment was announced by John R. Lausch, Jr., United
States Attorney for the Northern District of Illinois; Lamont Pugh III, Special
Agent-in-Charge of the Chicago Region of the U.S. Department of Health and
Human Services Office of Inspector General; and Jeffrey S. Sallet, Special
Agent-in-Charge of the Chicago office of the FBI. The Illinois Attorney General’s Office and
Illinois State Police assisted in the investigation. The government is represented by Assistant
U.S. Attorneys Prashant Kolluri and Charles W. Mulaney.
The U.S. Attorney’s Office and Illinois Attorney General’s
Office previously intervened in a civil lawsuit that a private citizen filed
against the foundation pursuant to the qui tam, or whistleblower, provisions of
the False Claims Act. The lawsuit is
pending in federal court.
Medicaid is a state-administered program, and each state
sets its own guidelines regarding eligibility and services. For Illinois Medicaid recipients, funding is
shared between the federal government and the State of Illinois.
The public is reminded that an indictment is not evidence of
guilt. The defendants are presumed
innocent and entitled to a fair trial at which the government has the burden of
proving guilt beyond a reasonable doubt.
The obstruction count is punishable by up to 20 years in prison, while
each health care fraud count carries a maximum sentence of ten years. If convicted, the Court must impose a
reasonable sentence under federal statutes and the advisory U.S. Sentencing
Guidelines.
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