The United States Attorney’s Office recently charged a psychologist with health care fraud. The prosecution stated the psychologist provided false claims for payment to Medicare and private insurance companies from 2011 through 2018. According to the indictment, the psychologist never provided the billed services.
To build their case, the prosecution pointed to evidence the psychologist could not have provided the services. In some cases, they stated, she was out of state on the date she claims to have provided the service.
Allegations and potential penalties
The government also alleges the psychologist used patient information to create fictitious claims. Overall, they charged the psychologist with five counts of health care fraud and three counts of aggravated identity theft. Each allegation of health care fraud can come with up to ten years of imprisonment and the identity theft charges come with at least two years imprisonment. If convicted of all charges, she faced 56 years of prison time.
Psychologist heads to court
Upon her arrest in October of 2018, the psychologist pled not guilty to the allegations. After discussions with the prosecution, she pled guilty earlier this year.
Earlier this month, a U.S. District Judge sentenced the psychologist to 6 months imprisonment and a fine of $100,000. She is also required to pay $1,464,810 in restitution to both Medicare and private insurers.
Lessons for other medical professionals
Anyone who bills Medicare and other health insurance companies should do so carefully. A failure to bill properly can result in allegations of health care fraud.