Tryon school counselor gets prison term for Medicaid fraud

Press release from the Department of Justice, Western District of North Carolina:

ASHEVILLE, N.C. – Joseph Frank Korzelius, 47, of Tryon, N.C. was sentenced yesterday to 24 months in prison for fraudulently billing Medicaid for more than $450,000 in false claims for mental and behavioral health services he did not provide, announced R. Andrew Murray, U.S. Attorney for the Western District of North Carolina. In addition to the prison term imposed, U.S. District Judge Martin Reidinger ordered Korzelius to serve three years of supervised release and to pay $436,229.08 as restitution to Vaya Health, the administrator of Medicaid funds in Western North Carolina.

U.S. Attorney Murray is joined in making today’s announcement by North Carolina Attorney General Josh Stein.

According to court documents and the sentencing hearing, from October 2013 to November 2016, Korzelius, a licensed professional counselor and a Medicaid-approved provider of mental and behavioral health services, owned and operated Western Carolina Counseling Services, located in Tryon. Korzelius was also employed as a school guidance counselor at Tryon Elementary School in Polk County. According to court records, Korzelius identified students and their siblings from his work at Tryon Elementary and used those potential beneficiaries’ information to access these individuals’ personal information. The defendant then used that information to create and submit billings for individual psychotherapy services when, in fact, no such services were provided.

Court documents show that Korzelius had minimal documentation to support his billings for services he fraudulently represented that he provided. Further, many recipients who Korzelius billed for indicated they never sought or received services from either Korzelius or Western Carolina Counseling Services. Filed court documents show that Korzelius controlled the bank accounts where the Medicaid approved reimbursements were deposited. During the course of his scheme, Korzelius submitted over $450,000 in false claims and received $436,229.08 in reimbursements for those fraudulent claims.

Korzelius pleaded guilty to one count of health care fraud. He will be ordered to report to the Federal Bureau of Prisons to begin serving his sentence, upon designation of a federal facility. All federal sentences are served without the possibility of parole.
The investigation was handled by the North Carolina Department of Justice, Medicaid Investigations Division (MID), and was prosecuted in the Western District of North Carolina by Special Assistant United States Attorney Timothy Rodgers through the MID’s participation in the Western District’s joint Health Care Task Force. The Task Force is a multi-agency team of federal and state investigators, working in conjunction with Civil and Criminal Assistant United States Attorneys, dedicated to identifying and prosecuting those who defraud the health care system and reducing the potential for health care fraud in the future. The Task Force builds upon existing partnerships between agencies and its work reflects a heightened effort to reduce fraud and recover taxpayer dollars.

If you suspect Medicare or Medicaid fraud please report it by phone at 1-800-447- 8477 (1-800-HHS-TIPS), or E-Mail at HHSTips@oig.hhs.gov. To report Medicaid fraud in North Carolina, call the North Carolina Medicaid Investigations Division at 919-881-2320.