The owners of a suburban Chicago youth counseling center have been sentenced to federal prison terms for bilking Illinois Medicaid out of approximately $2.5 million through a fraudulent billing scheme.
From 2011 to 2018, Summer Matheson and Terrence Ewing, co-managers 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.
Matheson, Ewing, and Grundy also used the Matteson, Ill.-based foundation to seek payment from Illinois Medicaid for non-reimbursable activities, such as internal case reviews, staff training, clinical supervision, and recordkeeping.
Matheson attempted 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 $2.5 million from Illinois Medicaid and managed-care organizations used by Illinois Medicaid.
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.
Matheson, Ewing, and Grundy each pleaded guilty last year to a federal health care fraud charge.
U.S. District Judge John Robert Blakey on Thursday sentenced Matheson, 46, of Chicago, to six years in federal prison, and Ewing, 62, of Chicago, to four and a half years. Judge Blakey previously sentenced Grundy, 39, of Chicago, to three years and a month.
