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Medicaid Cost Report Fraud

Published on February 25th, 2018

SCNow reported in 2013 that Richard C. Cooke pleaded guilty to several crimes connected to fraudulent activity in his operation of six nursing homes, including three in the Pee Dee.  Cooke pleaded guilty to two indictments charging him with forgery and four indictments charging him with medical assistance provider fraud.  Cooke was sentenced to 10 years on the two forgery indictments, suspended to five years probation and three years each on the Medicaid fraud charges, all suspended to probation. Cooke’s probation conditions include house arrest for one year and 500 hours of community service, plus the full restitution.  So Cooke steals more than a million dollars from the taxpayers and only gets probation?

“Fraud committed against the Medicaid program deprives funds needed to pay for medical services, including nursing home care for elderly citizens who can’t afford it otherwise,” S.C. Attorney General Alan Wilson said after the sentencing.

Indictments show Cooke submitted fraudulent cost reports to the South Carolina Medicaid program in his role in Cooke Management Company Inc. of Lake View, which operated six nursing homes across the state. Those nursing homes included Florence Rehab and Nursing Center in Florence, Sunny Acres in Fork and Kingstree Nursing Facility in Kingstree.

Under South Carolina Medicaid regulations, nursing homes are required to submit annual operational cost reports for their facilities. The Medicaid program pays the nursing home based on that and on the number of Medicaid residents. From 2009 through 2011, the six nursing homes Cooke oversaw were overpaid more than $1 million as a result of fraudulent items listed on cost reports submitted to Medicaid.

Under the terms of the plea agreement, Cooke was required to plead guilty to all charges, to make full restitution to the S.C. Medicaid program, to be excluded from the Medicaid program for life and to cooperate with the ongoing investigation by the S.C. Attorney General’s Office.

Joe Pioletti
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