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2 North Carolina men plead guilty to health care fraud conspiracy

Shawn Thorpe, Ruben McLain face up to 5 years in prison, fines

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JACKSONVILLE, Fla. – Two men face up to five years in prison and a fine of $250,000 in a conspiracy to commit over $1 million of health care fraud in Jacksonville.

Shawn Thorpe, 30, and Ruben McLain, 46, both of Winston-Salem, North Carolina pleaded guilty to conspiracy to commit health care fraud. 

According to the plea agreements, Thorpe and McLain agreed that McLain was an “excluded provider.”  He was prohibited from billing the federal health care programs for any services because of an earlier 2011 federal conviction for health care fraud.

Thorpe and McLain together worked to create and manage Coastal Bay, a company that provided medical care to Medicaid patients. Thorpe never disclosed to the Medicaid program that he was working with an individual who had been excluded from participating in the program. In an effort to conceal McLain’s involvement, McLain used an alias, “Julian Winchester.”

Using the alias, McLain performed a variety of functions, including hiring and firing individuals, seeing patients, and performing other managerial tasks. McLain routinely traveled from his home in North Carolina, to Jacksonville, to assist in Coastal Bay’s operations.

McLain and his family received significant financial benefits due to his involvement in Coastal Bay. Specifically, McLain had access to a Coastal Bay credit card, which he used to make routine purchases at restaurants, furniture stores, gas stations, and other places in North Carolina, even though Coastal Bay had no operations in North Carolina. In addition, McLain and his immediate family received more than $10,000 in direct payment withdrawals from the Coastal Bay business account.

By Wednesday, a sentencing date had not been set.