For Immediate Release:
Thursday, August 19, 2021
Nazneen Ahmed (919) 716-0060
Ruben Matos Sentenced to 3 1/2 Years in Prison, Ordered to Pay Nearly $2 Million in Restitution
(RALEIGH) Attorney General Josh Stein announced that Ruben Samuel Matos of Angier was sentenced to 42 months in prison and three years of supervised release for conspiracy to commit health care fraud. He was also ordered to pay $1,997,883 in restitution to the North Carolina Fund for Medical Assistance.
“This person took advantage of vulnerable people to steal and then sell their information,” said Attorney General Josh Stein. “He cheated the Medicaid program and taxpayers. My office will hold accountable people and businesses when they commit Medicaid fraud.”
Between 2014 and 2017, Matos conspired with multiple people and businesses to defraud the North Carolina Medicaid system by submitting more than $3.6 million in false and fraudulent claims for the reimbursement of behavioral health services. Matos partnered with Raleigh resident Reginald Van Reese, Jr. to canvass low-income neighborhoods to identify people who were eligible for Medicaid and collect their personal information and Medicaid identification numbers. They then sold that information to behavioral health companies so the companies could generate fraudulent claims for reimbursement of services that were never provided.
Matos and Reese worked closely with Antonio Deon Fozard of Durham, who controlled multiple behavioral health companies, to incorporate stolen Medicaid beneficiary and clinician data into false billings and to fabricate supporting medical documentation. Matos and Reese also worked with Luis Angel Lozada of Clayton who operated a behavioral health business to back-bill the Medicaid system using stolen Medicaid data and creating bogus medical records to substantiate the claims.
Reese was previously convicted of conspiracy in a related case. Fozard and Lozada have both pleaded guilty to health care fraud charges and are awaiting sentencing.
The investigation and prosecution of this case was conducted by the Medicaid Investigations Division, the U.S. Attorney’s Office for the Eastern District of North Carolina, and the Federal Bureau of Investigation.
About the Medicaid Investigations Division (MID)
The Attorney General’s MID investigates and prosecutes health care providers that defraud the Medicaid program, patient abuse of Medicaid recipients, patient abuse of any patient in facilities that receive Medicaid funding, and misappropriation of any patients’ private funds in nursing homes that receive Medicaid funding. To date, the MID has recovered more than $900 million in restitution and penalties for North Carolina. To report Medicaid fraud or patient abuse in North Carolina, call the MID at 919-881-2320.
The Medicaid Investigations Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $6,160,252 for Federal fiscal year (FY) 2020. The remaining 25 percent, totaling $2,053,414 for FY 2020, is funded by the State of North Carolina.