Raleigh Medicaid services provider convicted of fraud

tmcdonald@newsobserver.comOctober 31, 2013 

Gloria Sawyer


— A Raleigh woman who authorities say concealed her criminal past was sentenced to nearly two years behind bars and ordered to pay back nearly a half-million dollars after pleading guilty this week to stealing from North Carolina’s Medicaid program.

Gloria J. Sawyer, 54, of 1008 Southgate Dr., pleaded guilty Monday to five felony counts of obtaining property by false pretenses, Noelle Talley, a spokeswoman with the N.C. State Attorney General’s Office, reported Thursday.

Wake County Superior Court Judge Donald W. Stephens sentenced Sawyer to between 16 months and 20 months in prison and ordered her to repay the money to the Medicaid program from her work release earnings.

Sawyer operated a business called I Believe In Miracles, which provided case management services for people infected with HIV. Nearly 11 months ago, the N.C. State Bureau of Investigation accused Sawyer of collecting more than $480,000 in fees that she falsely billed to Medicaid.

HIV case management is designed to provide eligible patients with medically necessary services to enhance their health and ability to function. Investigators discovered a system of fraud in which Sawyer directed employees to create false documents and to backdate service notes in an attempt to conceal the fraud, according to Talley.

State authorities launched an investigation into Sawyer’s I Believe In Miracles in September of 2011 following a tip from a Medicaid recipient, who reported that the agency had billed Medicaid for services that she did not receive.

The probe by the attorney general’s Medicaid Investigations Division concluded that Sawyer billed Medicaid for more than $82,000 in 2009, more than $300,000 in 2010 and more than $92,000 in 2011.

The investigators found that Sawyer’s company did not provide many of the services for which she was paid or that the services were provided to patients who did not have HIV.

The investigators also learned that Sawyer concealed her criminal history to obtain a Medicaid provider number for I Believe In Miracles. State records show that in 2008 Sawyer pleaded guilty to income tax violations while at Cary’s Mission House, a transitional home for troubled women that she founded and led. She was sentenced to three years of probation.

Sawyer also served more than three years in prison in the early 1990s for drug violations. She also has past convictions for larceny, forgery, shoplifting and possession of stolen records, state records show.

“Medicaid cheaters harm needy patients, waste tax dollars and contribute to rising health care costs,” Attorney General Roy Cooper said in a statement Thursday. “This case is a prime example of the fraud and abuse our investigators and prosecutors are attacking.”

Sawyer was one of nine North Carolina health care providers arrested last December as part of a statewide Medicaid fraud sweep.

McDonald: 919-829-4533

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