Be On Your Best Behavior

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35104679 - classroom nursery with red chairs and small desks for children

Parents have an arsenal of sayings that are usually pretty effective at getting children to behave such as, ”Stop crying or I’ll give you something to cry about,” ”You’d better wipe that look off your face,” ”Don’t make me turn this car around,” and, ”You’d better be on your best behavior.” It’s ironic that today’s focus is on a former behavioral health counselor that had some behavior issues himself. In this role reversal he used his clients, who happened to be children, to try to bilk Oklahoma’s Medicaid program out of more than $14,000. (Let’s just say he should have known better.)

The former counselor submitted documents to his employer claiming that he had provided counseling services to three different children. Contrary to these claims, the caregivers of the children declared that the kids had never received services from the man. The former behavioral counselor used the children’s Medicaid identification numbers to fraudulently obtain payment from the state’s Medicaid program, despite the fact the services were never provided.

The former counselor pleaded guilty on two counts of Medicaid fraud and three counts of identity theft. (At least he didn’t throw a temper tantrum and actually exhibited adult behavior by taking responsibility for his actions.)The 28-year-old received a four-year deferred sentence and was ordered to pay more than $14,000 in restitution and fines. The man is also required to surrender all professional licenses. (He will not be allowed to work in a facility that cares for the elderly, vulnerable adults or kids under the Oklahoma Health Care Authority or any other federally-funded health care program for that matter.)

It remains to be seen if this perpetrator will meet the requirements of his deferred sentence, however, we can hope that he will behave like an adult. (The judge essentially disciplined this offender with the intention of correcting his bad behavior, but with a lenient approach. Kind of like a parent would do for a child in order to teach them a lesson.)Let’s hope the former counselor learns a valuable lesson from this experience and stays on his best behavior.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Former counselor pleads guilty to Medicaid fraud, identity theft,” published by Insurance Fraud News on November 4, 2016.

November 4, 2016, Oklahoma City, OK — A former behavioral health counselor pleaded guilty to Medicaid fraud and identity theft following charges brought by Attorney General Scott Pruitt.

Toris Emanuel Louie, 28, of Oklahoma City, submitted documents to his employer indicating that he provided counseling services to children that had never occurred. Louie also used the children’s personal Medicaid identification numbers to fraudulently obtain payment from the Oklahoma Health Care Authority for services that were never provided.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.