Marc H. Silverman, Acting United States Attorney for the District of Connecticut, announced on February 24, 2025, that a 44-year-old Hamden woman was sentenced to 37 months in prison, followed by three years of supervised release, for defrauding Medicaid of more than $1.6 million. In addition, she was ordered to pay full restitution and forfeit $114,085.55 seized from a bank account during the investigation.
According to court documents and statements made in court, the defendant was a state-licensed professional counselor and owner of a counseling services company located in North Haven. She provided psychotherapy to children, adolescents, and adults, with a particular focus on behavioral and mental health issues. The defendant was enrolled as a Behavioral Health Clinician provider in the Connecticut Medicaid Program.
Between January 2018 and March 2024, the defendant submitted fraudulent claims to Medicaid for psychotherapy services that were never provided. She billed for services under her own provider identification number for dates when no services were rendered. She also submitted claims for dates when she was either traveling out of state, on national holidays, weekends, or when the patients were in the hospital or no longer in treatment.
For example, during the week of March 9 to March 16, 2023, the defendant submitted 96 claims to Medicaid, representing 12 hours of in-person psychotherapy per day. Medicaid paid her $9,349.90 for these claims, though she did not treat a single patient that week. Instead, she was vacationing at Disney World, as evidenced by photos and posts on her public Facebook account.
In addition to her fraudulent claims, the defendant took several trips across the US, purchased tickets to over 30 concerts, shows, and sporting events, and spent over $150,000 on food delivery services, including Uber Eats, DoorDash, and GrubHub. She submitted more than 17,000 false claims, defrauding Medicaid of $1,647,031.51.
From January 2020 to May 2023, she was the highest paid behavioral health clinician in Connecticut enrolled in Medicaid. During this period, she received $826,355.91 in Medicaid reimbursements. Additionally, from November 2020 through September 2021, she fraudulently received $41,182 in unemployment benefits from the state of Connecticut, certifying that she was not working despite earning large sums from Medicaid.
The defendant, who is currently out on a $100,000 bond, is scheduled to report to prison on April 28.
Compliance Perspective
Issue
Medicaid service providers are obligated to bill honestly and maintain thorough documentation for all services they claim for reimbursement. Submitting false claims to Medicaid—whether knowingly or due to negligence—is illegal. False claims can lead to penalties, including fines up to three times the amount of the loss, plus $11,000 per fraudulent claim. Under the False Claims Act, each individual service or item billed to Medicaid counts as a separate claim, meaning penalties can escalate quickly. It is crucial for facility staff to understand how to recognize and report suspicious billing practices. A non-retaliatory reporting environment must be in place to encourage transparency and compliance.
Discussion Points
- Regularly review your facility’s policies and procedures related to preventing, reporting, and verifying the accuracy of Medicaid claims. These policies should be evaluated at least annually and updated whenever new information or guidance becomes available.
- Ensure that all staff members receive training on compliance and ethics policies, including recognizing and reporting false claims. This training should take place during onboarding and be repeated annually. Additionally, train appropriate personnel on the importance of accurate Medicaid billing and documentation.
- Periodically audit billing practices to ensure all staff are aware of compliance and ethics concerns and understand their responsibility to report any potential violations to their supervisor, the compliance and ethics officer, or via the anonymous hotline. Ensure that any identified irregularities are addressed promptly and appropriately.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*
