- The 4th US Circuit Court of Appeals has upheld a 200-month prison sentence for a man convicted of running a Medicaid fraud operation in North Carolina with nearly $12 million in bogus claims.
- The unanimous opinion detailed Donald Booker's role in lining up Medicaid-funded drug testing clients for his business.
- The court ruling spelled out more than $1.6 million in kickbacks paid to partners in the fraud.
The 4th US Circuit Court of Appeals has affirmed a 200-month prison sentence for a man accused of overseeing nearly $12 million in fraudulent Medicaid claims in North Carolina.
“Donald Booker owned and operated United Youth Care Services, which billed North Carolina’s Medicaid program for millions of dollars’ worth of medically unnecessary drug tests,” Chief Judge Albert Diaz wrote Tuesday for a unanimous three-judge panel. “He appeals his conviction on ten counts arising from this scheme. Finding no error, we affirm.”
Booker ran both United Youth Care Services, which offered substance-abuse treatment, and United Diagnostic Laboratories, which provided drug testing. “United Youth worked with partner organizations to recruit individuals to submit to drug testing for which the company could bill Medicaid,” Diaz wrote.
“The company used several medical providers to certify that the testing was medically necessary, even though those providers usually didn’t meet with the beneficiary,” the 4th Circuit opinion added. “Angela Johnson, a nurse practitioner, testified that she attested to medical necessity on several patient forms, even though she generally didn’t see the patient or make an individualized determination of necessity.”
“Booker set the protocols for the drug testing scheme,” Diaz wrote. “His right-hand man at the company, Richard Graves, testified that Booker directed testing of all participants in the company’s programs twice per week, regardless of individual medical need. These tests used the same testing panel (meaning samples were tested for the same set of drugs), regardless of a beneficiary’s personal clinical needs. Graves also testified that Booker was part of the group that decided which tests to run on beneficiaries.”
Recruitment for the “fraudulent enterprise” involved two groups. Do it 4 the Hood was a “counseling and mentoring program for at-risk youth.” In return for a regular supply of Medicaid-eligible young people to be tested, United Youth paid the group “about $124,000 in kickbacks,” Diaz explained.
Legacy Housing operated “boarding houses for recovering addicts and alcoholics.” After lining up tenants for drug testing, United Youth paid the firm’s owner “nearly $1.5 million in kickbacks,” the 4th Circuit opinion added.
“Booker also personally benefitted from the Medicaid fraud scheme,” Diaz wrote. “At trial, Booker testified on cross-examination that $1 million was debited from United Youth’s bank account on the same day that Booker deposited $1 million into his personal bank account. On redirect, he testified that he had a $1.5 million line of credit with the bank.”
A grand jury indicted Booker on 10 counts: “conspiracy to defraud the United States, to commit health care fraud, and to pay illegal kickbacks (Count One); five counts of violating the Anti-Kickback Statute … (Counts Two through Six); one count of conspiracy to launder money (Count Seven); and three counts of concealment money laundering (Counts Eight through Ten).”
A jury convicted Booker on all counts. US District Judge Kenneth Bell’s sentence of 200 months in prison fell 10 months short of the federal sentencing guideline range of 210-262 months.
Appellate judges rejected Booker’s arguments to have his conviction overturned.
“[T]he jury heard abundant evidence that Booker owned United Youth and set the company’s drug-testing policies,” Diaz wrote. “Graves testified that Booker required that all referred beneficiaries be tested twice per week (and instructed which tests to run) regardless of individual medical need. This testimony is direct evidence of an unlawful agreement and Booker’s willful participation in the same. That the jury found Graves credible isn’t a basis for disturbing its findings.”
“What’s more, Booker ignores overwhelming evidence of his role in paying illegal kickbacks,” Diaz added. “Multiple witnesses testified that Booker negotiated kickback arrangements with Do It 4 the Hood and Legacy Housing, wherein United Youth paid these entities for their help finding Medicaid beneficiaries to be drug tested. The jury also heard ample evidence of Booker’s awareness of, and involvement in, making kickback payments to both entities.”
“Booker throws much against the wall to persuade us to reverse the district court’s denial of his motion for judgment of acquittal. None of it sticks,” Diaz wrote.
Judges Steven Agee and DeAndrea Gist Benjamin joined Diaz’s opinion.