Misdiagnosed

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An Institute of Medicine report estimates that 30 cents of every healthcare dollar are wasted in unnecessary healthcare costs, many related to misdiagnoses. (That adds up to about $750 billion a year.) A Powell, Wyoming psychologist committed Medicaid fraud by misdiagnosing patients with mental health disorders so he could bill Medicaid for more than $2.2 million in services and treatments that were not necessary.

The fraudster from Wyoming ordered his staff, who were mostly unlicensed, to perform the mental health assessments. The untrained staff routinely reported that the Medicaid beneficiaries assessed had a qualifying mental health disorder that could be treated and paid for by the government healthcare program, even though the licensed psychologist had not properly supervised the assessments. (Think of the repercussions of being misdiagnosed with a mental health disorder by an untrained and unlicensed staff member?)

Based on the erroneous assessments, the psychologist’s office submitted bogus bills for the improperly conducted assessments and completed treatments even though they were not needed. He also slipped in some other claims for life skills training, psychological and social rehabilitation and adult case management services even though the Medicaid beneficiaries had not been properly diagnosed with a mental health disorder. (Many of these activities didn’t qualify as medically necessary therapy because the psychologist did not operate a qualified community mental health center.)

 The psychologist’s misrepresentations and false claims netted him $2,283,792.49 for mental health services that didn’t qualify for Medicaid reimbursement. He passed along a portion of the proceeds from the fraud scheme to his unqualified staff who assisted in the scheme. (Let’s just call it was it is – a kickback.)

The 57-year-old Powell, Wyoming psychologist pleaded guilty to one count of healthcare fraud as part of a plea agreement. He was sentenced to serve three years in prison for Medicaid fraud and must pay approximately $2.28 million in restitution to the Wyoming Department of Health and the U.S. Department of Health and Human Services. (He’ll also have to forfeit any assets related to the proceeds he illegally collected.)

A misdiagnosis of a mental health condition can be dangerous. If a wrong diagnosis is made, then the wrong medication and treatment may be prescribed. Also, a patient could be devastated by an incorrect diagnosis, causing repercussions that negatively impact their life and their caregivers. (Fortunately, the justice system has made the correct diagnosis in this case – guilty. Let’s hope a dose of prison will cure this former psychologist’s lack of scruples.)

 Today’s “Fraud of the Day” is based on an article, “Wyoming Psychologist sentenced for Health Care Fraud today,” posted on county10.com on January 8, 2018.

Gibson Buckley Condie, 57, of Powell, Wyoming, was sentenced on January 8, 2018, to serve three years in prison for felony health care fraud involving mental health services falsely billed to Wyoming Medicaid, announced United States Attorney Mark A. Klaassen. Condie was also ordered to pay approximately $2.28 million in restitution to the Wyoming Department of Health and the United States Department of Health and Human Services, and forfeit certain assets traceable to the proceeds of his fraud.

Condie, who was a licensed psychologist, had been indicted by a federal grand jury in May 2017 for a scheme to defraud Wyoming Medicaid. Condie pled guilty to one count of health care fraud as part of a plea agreement with the United States government. Condie admitted to operating a scheme involving a number of misrepresentations and false statements intended to cause Medicaid to pay for mental health services for which he knew Medicaid would not pay if he truthfully reported the facts.

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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.