Licensed Professional Counselor Sentenced to Prison for $1.3 Million Medicaid Fraud Scheme
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 million, announced the U.S. Attorney for the U.S. District of Connecticut. In addition to the prison time, he was sentenced to three (3) years of supervised probation upon release and ordered to pay restitution to Medicaid in the amount of $1,313,322.
A Wide-Ranging Fraud Scheme.
According to court documents, from 2014 to 2020, the defendant was a licensed professional counselor with offices in Hartford, Connecticut. Additionally, he owned two entities through which he managed group homes, including residences for women and children who were victims of domestic abuse.
According to prosecutors, he defrauded Medicaid from August 2018 through October 2020 by submitting claims for psychotherapy services never provided to patients. In addition, on a limited number of occasions, some of the services were rendered by unlicensed individuals who were not qualified or licensed to provide psychotherapy, the U.S. Attorney’s Office reported but were billed to Medicaid.
Taking Advantage of Tenants.
The former counselor required tenants of group homes to provide copies of their Medicaid member cards for themselves and their children as a condition of residency, said, prosecutors. Then he used the Medicaid numbers from the tenants to bill for bogus psychotherapy services. He used the numbers of approximately 65 tenants or their children to fraudulently bill Medicaid for roughly $543,117 in services that were never performed, court documents stated.
Scheming as a School Guidance Counselor.
The counselor did not stop there. In 2019, New Haven Public Schools hired him as a guidance counselor at the New Haven Adult and Continuing Education Center.
In February 2020, he apparently continued the same procedures when he accessed a database containing personal identifying information of current and former students, many of whom he did not have any professional relationship with and had never met. He used the Medicaid numbers of approximately 135 New Haven students to bill Medicaid and was paid approximately $593,383 from fraudulent claims.
The U.S. Attorney’s Office’s Civil Division stated that the Connecticut Department of Social Services, working in cooperation with law enforcement, suspended Medicaid payments to the defendant. They recovered $337,777.63 that he was scheduled to receive from Medicaid from billings that had been submitted. They also seized and forfeited $412,415.20 from the former counselor’s bank accounts. Additionally, the defendant paid restitution of $20,000, leaving a restitution obligation of $543,129.17.
The Connecticut Medicaid program initially suspended him as a Medicaid provider on April 28, 2020, and he was formally arrested on October 14, 2020. To learn more about the case, click here to read the press release from the U.S. Department of Justice (DOJ).
To read about a similar case involving a health care office manager convicted in a fraud case, click here.
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Valinot, Nicole. “Hartford County Man Sentenced For Wide-Ranging $1.3M Medicaid Fraud Scheme.” Daily Voice. (March 13, 2022). Web.
Rhatigan, Chris. “CT Counselor Sentenced In $1.3 Million Medicaid Fraud Case: Feds.” (March 14, 2022). Web.
Pantini, Liz. “In The News: Counselor Pleads Guilty in Wide-Ranging Medicaid Fraud Scheme.” Yale School of Medicine. (January 25, 2022). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714; Phone: (407) 331-6620; Toll-Free: (888) 331-6620.
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