The Department of Justice (DOJ) continues to crackdown on allegations of healthcare fraud. The agency’s most recent examples a psychologist and his wife who ran a psychological practice. The government has accused the couple of partaking in an elaborate billing scheme to defraud Medicaid.
Allegations explained: Couple accused of fraudulent billing practices
The agency has accused the couple of fraudulently billing Medicaid for mental health services. The allegations are connected to group therapy services provided in the psychological practice the couple ran from 2012 through 2016. The government has claimed these services did not qualify within the government’s definition of group therapy. The government states the couple failed to use “up-to-date treatment plans to guide each Medicaid beneficiaries’ treatment” as required by law. As such, hours billed for group therapy sessions provided at the practice were deemed an illegal attempt to fraudulently bill Medicaid.
The agency also accused the couple of providing falsely backdated treatment plans during an audit of the psychological practice. The government has stated the couple intentionally provided false treatment plans and false statements to conceal their involvement in the scheme.
Government success: Couple takes a plea deal
Ultimately, the couple chose to enter a negotiated plea with the government. The husband and wife pled guilty to the charges and face sentencing in December of 2018.
Lesson for medical professionals: Get a lawyer
The government will continue to investigate and prosecute allegations of healthcare fraud. Take the notice of an investigation seriously. Contact an attorney to build a defense and protect your rights.