Charlotte Licensed Clinical Social Worker Convicted Of Medicaid Fraud, COVID-19 Relief Fraud, And Money Laundering

CHARLOTTE, N.C. – A Charlotte behavioral health services provider was convicted today by a federal jury following a nine-day trial, for defrauding the South Carolina Medicaid Program (SC Medicaid), falsely obtaining COVID-19 relief funds, and money laundering, announced Dena J. King, U.S. Attorney for the Western District of North Carolina.

Robert M. DeWitt, Special Agent in Charge of the Federal Bureau of Investigation (FBI), Charlotte Division, and Stephanie G. Opet, Director of the South Carolina Medicaid Fraud Control Unit, join U.S. Attorney King in making today’s announcement.

Ashley Nicole Cross, 41, of Charlotte, was found guilty of healthcare fraud, making false statements and writings relating to a healthcare matter, promotional money laundering, wire fraud, and conspiracy.

According to trial evidence—including 25 witnesses and over 600 documents—Cross owned and operated Odyssey Health Group (OHG), a Charlotte-based company, which was enrolled with SC Medicaid to provide outpatient behavioral health services to eligible Medicaid beneficiaries. Under SC Medicaid rules, beneficiaries are allowed to use providers within 25-miles of the South Carolina border, including Charlotte. From 2016 to 2021, Cross’s company submitted fraudulent reimbursement claims to SC Medicaid and its contracted managed care organizations for rehabilitative behavioral health services that were never provided. To carry out the scheme, Cross used the personal identifying information (PII) of qualified SC Medicaid beneficiaries to file reimbursement claims totaling $1.3 million dollars. For some claims, Cross bought the PII of Medicaid beneficiaries she used to submit claims. To further the scheme and to give the appearance that OHG’s fraudulent claims were legitimate, Cross instructed OHG employees to create fake clinical service notes after she filed fraudulent claims in the names of Medicaid beneficiaries.

Trial evidence established that in September 2019, Cross was informed of audits of OHG’s Medicaid claims. To cover up the fraud, Cross submitted fictitious patient medical records and made false statements to auditors. Trial evidence further established that Cross engaged in money laundering and used some of the fraudulent proceeds to promote the scheme by paying for Medicaid beneficiary names and PII.

In addition to the Medicaid fraud scheme, evidence showed that from April 3, 2020, to May 14, 2022, Cross executed a scheme to obtain fraudulent Paycheck Protection Program (PPP) loans on behalf of OHG and Gucci International Inc. (Gucci), a purported event planning business owned by Cross’s boyfriend and co-conspirator. To obtain the PPP loans, Cross submitted loan applications and supporting documents that contained false statements regarding OHG’s and Gucci’s payroll expenses, number of employees, and other misrepresentations. Cross obtained more than $287,000 in COVID-19 relief funds for her companies and Gucci. At the time of Gucci’s loan application, Cross’s boyfriend was under indictment for a federal offense.

Cross was remanded into custody after the jury returned its verdict. A federal district court judge will determine Cross’s sentence after considering the U.S. Sentencing Guidelines and other statutory factors. A sentencing date has not been set.

The FBI investigated the case with substantial assistance from the South Carolina Attorney General’s Office, Medicaid Fraud Control Unit, and the Small Business Administration’s Office of Inspector General.

Assistant U.S. Attorneys Michael E. Savage and Cassye Cole, and Special Assistant U.S. Attorney Kristina Fleisch of the U.S. Attorney’s Office in Charlotte prosecuted the case.