Facing Change

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Stethoscope on 100 dollar bills symbolizing financial surveillance

The owner of a Lewiston, Maine counseling agency named “Facing Change” is ironically facing a great deal of change in her own life after being convicted for committing Medicaid fraud. She used her mental health and substance abuse counseling agency to steal more than $660,000 from the state’s health care program.

As many fraudsters do, the owner conspired with another person – a Somali interpreter – to carry out her Medicaid fraud scheme. For approximately two-and-a-half years, the owner paid the interpreter kickbacks in exchange for referrals. Then, the two co-conspirators plus other employees at the counseling center prepared and submitted false claims to MaineCare.

In 2016, MaineCare made a regulatory change involving reimbursement eligibility. The change prompted the co-conspirators to change the diagnosis of many of the counseling agency’s clients to schizophrenia so they could continue to receive reimbursement from MaineCare. (How would you like your mental health record to indicate you have schizophrenia when you don’t?)

The co-conspirators were quite brazen in their attempt to defraud, even during an audit of the Lewiston-based counseling agency. The owner and many of her employees manufactured fake records to throw the auditor off course. The fraud ended in May 2018, when federal and state agents executed a search warrant at the mental health and substance abuse agency.

A three-year collaborative investigation conducted by the Department of Health and Human Services, Federal Bureau of Investigation, and the Maine State Medicaid Fraud Control Unit led to the owner’s Medicaid fraud conviction. A 42-month prison sentenced to be followed by three years of supervised release was a huge clue that the 64-year-old would be facing significant change in her life. It probably really sunk in when she learned that she also must pay restitution of $660,902 to MaineCare. (Maybe she should seriously look into getting some counseling while behind bars. The former owner of the Maine counseling agency will definitely have plenty of time to work through all of the bad things she has done to her vulnerable patients and make amends.)

Today’s Fraud of the Day comes from a Department of Justice Press Release, “Owner of Lewiston Counseling Agency Sentenced for Health Care Fraud,” posted by AllOnGeorgia.com on February 12, 2020.

Portland, Maine: A Lewiston woman was sentenced today in federal court in Portland for conspiring to commit health care fraud, U.S. Attorney Halsey B. Frank announced.

U.S. District Judge Jon D. Levy sentenced Nancy Ludwig, 64, to 42 months in prison and three years of supervised release. Ludwig also was ordered to pay $660,902 in restitution to MaineCare. A jury had found Ludwig guilty of nine counts of health care fraud on June 14, 2019, after a five-day trial.

 

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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.