Family Therapy

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Family plays an important role in how its members develop emotionally, physically and spiritually, because each individual is impacted by other family members. Sometimes, there is a need to address mental health concerns that affect the family as a whole, including issues such as depression, substance abuse, chronic illness, marital problems, or childhood behavior through family therapy. You could say that today’s fraudster from Torrington, Connecticut came from a family that had fraud issues. Together with his mother, they committed Medicaid fraud by using other family members to steal more than $1.6 million for family therapy services that were never provided.

Let’s analyze the facts to break down the dysfunction in today’s fraud case. The Connecticut man, his mother and another individual formed a social services agency in Torrington. (The man served as the agency’s office manager.) His mom and the other individual approached a licensed clinical social worker, who owned and operated her own counseling agency in Canton and Bantam and asked her to go in on a Medicaid fraud scheme. (The mom and other individual worked out a deal to use the social worker’s Medicaid provider number in exchange for a portion of the proceeds from the ruse.)

The social worker agreed to the illegal arrangement and the office manager billed Medicaid for psychotherapy services that were either performed by unlicensed individuals or not performed at all. The office manager apparently submitted hundreds of claims to Medicaid for therapy services supposedly provided to members of his family, including his own children, nieces and nephews. (They never received any such services.) He also helped provide false documentation regarding the type of services his family members received.

The co-conspirators in this case submitted fraudulent claims worth $1.6 million. The mother received more than $1.2 million from the fraud scheme. The social worker who allowed the illegal use of her Medicaid provider number received 25 percent, which the remaining 75 percent went to the mother and the other individual involved. (It sounds like the son was cut out of the deal.)

 

The 46-year-old Torrington man was sentenced to five years of probation for committing healthcare fraud by submitting false claims for family therapy services that were never provided by a licensed social worker. He is also required to pay $211,131 in restitution for his part in the crime. His mom received 21 months in prison and six months of home confinement, while the social worker received a 10 month sentence. They both pleaded guilty to healthcare fraud. (The two co-conspirators must pay back $1.6 million in restitution.)

 

The family members involved in today’s fraud case need more than a few therapy sessions to figure out how to solve their dysfunction. (For instance, it might be difficult to explain why grandma is going to prison.) This is a case of where the justice system is exercising tough love. Perhaps all of the criminals involved in this Medicaid fraud case will learn how to finally take responsibility for their actions.

Today’s “Fraud of the Day” is based on an article entitled, Torrington man gets probation in health care fraud case,” published by The Register Citizen on May 25, 2018.

A Torrington man was sentenced this week to five years of probation for committing health care fraud, according to the U.S. attorney’s office.

U.S. District Judge Victor A. Bolden also ordered Maurice Sharpe, 46, to pay restitution of $211,131 in the case, according to a release.

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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.