Shrinking Fraud Down to Size

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26578311 - male nurse pushing stretcher gurney bed in hospital corridor with male & female doctors & nurses & senior female patient in a wheelchair

There are several situations where having a personal reference is helpful. For example, when you’re applying for a job, it doesn’t hurt to provide the names of individuals who can vouch for your work ethic and trustworthiness. If you’re trying to get into an undergraduate or graduate program, a letter from a former coach or teacher could enhance your ability of being accepted. And, if you’re standing before a judge to be sentenced, it’s always helpful to have reference letters to vouch for your character. (But, if you’re about to be sentenced by a judge, there’s probably a character issue.) A psychologist from Powell, Wyoming tried the personal reference route before being sentenced for Medicaid fraud, but it doesn’t appear to have helped him much.

Today’s fraud article states that the psychologist got caught lining his pockets with nearly $2.3 million in federal and state money at a time when Wyoming was cutting its budgets for needed services. (He was originally accused of submitting approximately $6.8 million in bogus bills to his state’s Medicaid program over nearly four years.)

The bills he submitted for payment claimed he was the treating provider, but nearly all the services were actually provided by individuals who were unlicensed and not enrolled as a qualified Medicaid service provider under the Wyoming Medicaid Program. (So, patients were having their heads examined by unqualified providers. That’s a bit troublesome.)

In addition to false billings, he routinely endorsed mental health assessments for Medicaid beneficiaries that indicated his patients had a qualifying mental health disorder. He didn’t perform the exams, nor did he supervise the assessments. (That’s a dangerous place to be in for patients, because misdiagnoses could impact their lives in a negative manner.) The improperly performed assessments led to medically unnecessary treatments as you might guess. (Additional research shows that most of the treatment the psychologist billed Medicaid for did not qualify as therapy.)

So, what did he do with the $2,283,792.49 he illegally obtained from the Wyoming Medicaid program? He used some of it to help out his neighbors, patients and the community. That includes paying several months of rent for one man and paying to rebuild an elderly woman’s broken lawn sprinkler. (These are just a few of the Robin Hood-esque things he did. While Robin Hood stole money from the rich to give to the poor, the psychologist was stealing from the poor to make himself rich.)

Despite more than 30 personal reference letters attesting to the psychologist’s character, the judge sentenced the 57-year-old Wyoming man to three years in prison to be followed by three years of supervised release. The State of Wyoming and the federal government will split the nearly $2.3 million in restitution he must pay back.

It looks like Medicaid did a great job of analyzing and shrinking this man’s fraudulent acts down to size. His crimes serve as an important message to other Medicaid providers who are considering stealing from vulnerable beneficiaries. It’s a privilege to serve as an official Medicaid provider and those who are not responsible with taxpayer dollars and do not treat their patients with honesty and transparency, will pay dearly.

Today’s “Fraud of the Day” is based on an article entitled, Wyoming psychologist sent to prison for health care fraud,” published by The Seattle Times on January 8, 2018.

CHEYENNE, Wyo. (AP) — A federal judge wasn’t influenced Monday by dozens of letters supporting a Wyoming psychologist who admitted to stealing money from Medicaid and ordered him to serve a three-year prison sentence and pay nearly $2.3 million in restitution.

U.S. District Judge Alan Johnson on Monday also imposed three years of supervised release after Gibson Condie, of Powell, serves his prison time for one count of health care fraud.

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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.