The United States Attorney for the Eastern District of Texas recently announced the agency was moving forward with criminal health care fraud charges against a mental health provider.
The government has accused the counselor of fraudulently billing Medicare, Medicaid and private insurance companies for counseling services. According to the allegations, the health care professional billed these insurance providers for $591,600.69 for services that require face-to-face sessions. The codes at issue do not allow for the taking of administrative time to update the patient’s records or address billing matters. The prosecution states the counselor erred, using codes for 30-minute, 45-minute and 60-minute face-to-face sessions that did not occur.
Upon facing these allegations, the accused chose to agree to a guilty plea. The court will move forward with sentencing at a later date. It is important to note that the plea may come with more favorable penalties. If the prosecution had built a strong enough case to gain a conviction, the counselor would have faced up to 10 years of sentencing for each charge.
We will provide an update in the future if pertinent, but the main takeaway from this case is the fact that the government will pursue health care fraud charges against anyone it believes fraudulently bills Medicare or Medicaid. This investigation took a number of months and was conducted by multiple government agencies. Health care professionals who are under an investigation like in this case are wise to take the matter seriously and promptly seek legal counsel. An attorney experienced in these matters can begin building a defense and discuss your options, working to better ensure a more favorable outcome on your behalf.