An investigation led by the Nevada Attorney General’s Medicaid Fraud Control Unit (MFCU) has resulted in the conviction of eleven individuals involved in a behavioral health fraud scheme in Southern Nevada. The case centered on two mental health Medicaid provider businesses, Top Notch Behavioral Health and Shepherds Heart Services, which were found to have submitted false claims to Medicaid for services that were not provided.
The MFCU began its investigation in July 2017 after identifying suspicious billing practices. Further inquiry revealed that the fraudulent activities extended beyond these two companies and involved a network of individuals and providers connected through a church operated by Greg and Carol Kirby. According to authorities, some providers billed Medicaid for more than twenty-four hours of service per day, claimed practitioners worked for their companies when they did not, and failed to disclose criminal histories when enrolling as Medicaid providers.
Attorney General Aaron D. Ford stated, “I am proud of the work of the Medicaid Fraud Control Unit in working with other agencies to investigate this case and obtain convictions against these individuals to hold them accountable. My office will continue to hold people and companies that defraud the Medicaid system accountable and ensure Medicaid funds are available for those people that are in need of services.”
Due to allegations involving potential IRS fraud, the United States Attorney’s Office (USAO) for the District of Nevada prosecuted the case. MFCU staff played a key role by testifying before federal grand juries, assisting with claims analysis, and providing expertise on behavioral health fraud cases.
The investigation led to court-ordered restitution totaling approximately $5.5 million to be repaid to Medicaid. The MFCU investigates financial fraud related to healthcare services or goods provided to Medicaid patients as well as instances of elder abuse or neglect. The unit receives most of its funding from the U.S. Department of Health and Human Services under a grant award, with additional support from the State of Nevada.
Persons convicted of Medicaid fraud may also face exclusion from future participation in both Medicaid and Medicare programs.
Anyone wishing to report suspected fraud or abuse can contact the MFCU at 702-486-3420 or 775-684-1100.
This case was investigated by the Attorney General’s Medicaid Fraud Control Unit.