On February 15, 2013, Dennis Keyes, Ph.D., a school psychologist certified in the state of South Carolina signed a Cease and Desist Affidavit and Assurance of Voluntary Compliance issued by the Kentucky Office of the Attorney General, agreeing that he may not engaged in the practice of psychology in the state of Kentucky without a valid credential nor use in Kentucky the term “psychologist,” “psychological” or similar terms that could be reasonably interpreted to mean that he was licensed as a psychologist in the state of Kentucky. Keyes performed a psychological evaluation on a criminal defendant for purposes of a Kentucky criminal case before a Kentucky court when he was not licensed in the state of Kentucky.
June 25, 2013
On May 29, 2013, San Diego, California psychologist Roberto Velasquez was sentenced to 21 months in federal prison and ordered to pay $1.5 million for health care fraud.
According to the U.S. Attorney’s Office, Velasquez took kickbacks from patients to certify them as disabled. Velasquez admitted he submitted fraudulent reports to the Social Security Administration, falsely certifying that certain patients were eligible for disability benefits when he knew they were not. He also admitted falsifying certain forms used by the Department of Homeland Security during the naturalization process, allowing certain immigrants to avoid taking the English language and Civics portions of their citizenship exams.
State audit shows New Mexico behavioral health facilities overbilled federal and state government by tens of millions of dollars
ALBUQUERQUE, N.M. (AP) – Fifteen New Mexico providers of mental health and substance abuse services failed to meet standards, overbilled the federal and state government by tens of millions of dollars, and may have taken part in fraudulent activities, according to a new state audit released Monday.
New Mexico Human Services Department officials said the audit found that “errors and overpayments were so widespread that the business and billing practices of every provider (in the audit) warrants careful scrutiny.”
It also found “mismanagement, fraud, waste and abuse” in the treatment of potential suicide victims, including disregard for follow-up care and basic policies.
Department Secretary Sidonie Squier said that, as a result of the audit, Medicaid payments would stop immediately to all 15 providers and out-of-state managers would be brought to New Mexico to manage behavioral health care services for patients.
In addition, she said the results of the five-month audit have been forwarded to the New Mexico Attorney General’s Office for further investigation of potential fraud.
“New Mexico can’t risk this type of activity,” Squier said in an interview with The Associated Press.
The audit did not list the names of the providers targeted. But state officials said they accounted for more than 85 percent of the state’s behavioral health spending for more than 30,000 patients.
Providers contacted by the AP did not immediately return phone messages.
New Mexico has some of the highest suicide and drug overdose rates in the country, with 19.9 suicides per 100,000 people. The national suicide rate is 12.4 deaths per 100,000, according to the Centers for Disease Control and Prevention
The audit also found that providers overbilled taxpayers by $36 million and that the companies had error billing rates that far exceeded the national average.
A licensed Marriage and Family Counselor was arrested today for allegedly submitting dozens of false claims for payment to the state’s Medicaid program. Medicaid is a federal system of health insurance for those requiring financial assistance that is subsidized by federal and state funds.
CATHERINE A. REARDON, age 49, of Crescent Street, Groton, is accused of defrauding Medicaid of more than $3,500 by submitting 72 claims for counseling services that were not provided to seven current or former clients.
Ms. Reardon was arrested by Inspectors from the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney and charged with First Degree Larceny by Defrauding a Public Community, a class B felony punishable by up to 20 years in prison, and Third Degree Identity Theft and Insurance Fraud, both class D felonies each punishable by up to 5 years in prison.
According to the arrest warrant affidavit, between 2011 and 2012 Ms. Reardon billed Medicaid for counseling supposedly provided to clients who had stopped using her services and also billed Medicaid for family therapy sessions when she had provided only individual therapy. Family therapy is reimbursed at a higher rate.
The charges against Ms. Reardon are merely accusations and she is presumed innocent unless and until proven guilty beyond a reasonable doubt.
Bond was set at $25,000 during her arraignment today in Hartford Superior Court at G.A. No. 14. Her next court appearance is scheduled for Monday.
The case is being prosecuted by the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney.
CLEVELAND – A local psychiatrist who admitted that he used his practice to illegally prescribe powerful drugs for profit was sentenced Tuesday to nine months in prison.
In April, Dr. Samuel Nigro pleaded guilty to charges that include drug trafficking, tampering with drugs and attempting to engage in a pattern of corrupt activity.
Assistant Cuyahoga County Prosecutor Dan Kasaris told FOX 8, “Drug addicts went to him for pills. Now there probably were some who did go to him for psychiatry, but they’re shoppers. Doctor shoppers find out where to go, where to go to get their pills.”
The pill mill operated by 76-year-old Nigro was exposed during an investigation by the Ohio State Pharmacy Board and the Cleveland Police narcotics unit. Undercover informants, who were sent to Nigro’s offices in Beachwood and Lakewood wearing recording devices, asked for and received prescriptions, with few questions asked.
“You know my back hurts, I was dancing on a pole and my back hurts me,” said Kasaris.
Investigators say the doctor also ran his drug business out of his home in Cleveland Heights. Kasaris said patients would pay Nigro $100 to $200 for prescriptions for powerful drugs like Oxycontin, Oxycodone, Percocet and Adderall.
As part of a plea agreement, Dr. Nigro agreed to forfeit $150,000 he made trafficking in drugs, and pay an additional $100,000 to cover the cost of investigating and prosecuting the case.
Nigro was a decorated Vietnam War veteran, and had once been a respected psychiatrist. “But when you have a professional who at the end of his career, you know, goes to the dark side, that’s something that we take very seriously,” said Kasaris.
Nigro surrendered his medical license and could have faced 14 years in prison.
June 21, 2013
Dozens of therapists who were unlicensed or improperly supervised routinely treated mentally ill patients at three clinics owned by a major provider of care to low-income people in Massachusetts, state records show.
At an Arbour Health System clinic in Lawrence, state inspectors determined that all 23 therapists were not qualified to see patients on their own, yet were doing so without regular oversight by a licensed professional. Similar staffing violations were discovered at Arbour clinics in Malden and Fall River.
The findings last year, described in documents obtained by the Globe and filed as part of a lawsuit, highlight a two-tier system in which low-income patients often are treated by mental health workers with less training and expertise than caregivers for privately insured patients.
The suit, being considered by a federal judge this week, centers on the care that teenager Yarushka Rivera received at the Lawrence clinic. Unlicensed Arbour therapists counseled Rivera and diagnosed her with biploar disorder, according to state records filed in the case, brought by the girl’s parents. They allege that a nurse working without adequate supervision prescribed an antiseizure medication often given for mood disorders though not federally approved for such a use.
Rivera, called Yari by her friends, developed a seizure disorder after she stopped taking the drug. In October 2009, soon after graduating from Essex Agricultural and Technical High School, she suffered a seizure and died at age 19. The family’s suit does not blame Arbour for Rivera’s death but instead seeks redress by claiming the company fraudulently billed government insurance programs.
The state Department of Public Health, which regulates community mental health centers, required Arbour last year to develop plans to fix the problems at the cited clinics. Among other steps, the company promised to hold regular supervisory meetings with therapists and improve monitoring by clinic directors.
Dr. Madeleine Biondolillo, director of the department’s Bureau of Health Care Safety and Quality, said the pattern of deficiencies is concerning, but she is satisfied with Arbour’s promise to do better.
“This is an organization that has broad reach,” she said. “It’s a very, very important service that they provide, and it has to be done according to the regulations.”
Arbour operates five psychiatric hospitals and 11 mental health clinics in Massachusetts. Its for-profit parent, Universal Health Services, is a publicly traded company that earned more than $443 million last year and has staked its future largely on expanding in the behavioral health care market.
State regulations allow unlicensed workers to see patients in community mental health clinics, which serve large numbers of people who are low income or have serious mental illness — but only if those workers are regularly supervised by licensed mental health professionals. The practice is meant to ensure access to affordable mental health providers and to provide experience to therapists applying for licensure. Unlicensed workers can also fill a need for caregivers who speak Spanish or another language.
But the supervisory lapses at Arbour show that the state policy, if not aggressively enforced, can contribute to a care gap: People with top-shelf commercial insurance plans or who can afford to pay cash get access to fully licensed social workers, psychologists, or psychiatrists, while those who are low income may see clinicians with far less training.
Rivera’s mother and stepfather, Carmen Correa and Julio Escobar, noted in one of the numerous complaints they filed with the state that it makes little sense for Massachusetts to allow unlicensed workers to treat sick patients when even manicurists must be licensed. State rules “fail to protect our most precious treasure and most vulnerable, which are our mentally disabled children,” they wrote.
Rivera’s parents filed their lawsuit against Universal Health Services in federal court in Boston in 2011, alleging that the company defrauded the state and federal government by charging for services provided by therapists unqualified to care for their daughter, who was covered by Medicaid.
They declined to comment for this story. If they win their case, the couple would receive a portion of what the government recoups in payments made to Arbour.
Universal has argued that the case does not belong in court because the issues raised are a matter of compliance with state regulations, not of federal fraud. US District Judge Douglas P. Woodlock heard arguments Wednesday afternoon on the company’s motion to dismiss the suit but made no immediate ruling.
Mark Pearlstein, Universal’s attorney, said in an e-mail that the family’s complaints have not resulted in fines or revocation of the clinics’ licenses. Some Lawrence employees have been disciplined by state licensing boards, however.
Arbour “is defending this case vigorously and expects to be vindicated when the matter is ultimately concluded,” Pearlstein said. The company’s lawyers declined to comment on the state inspectors’ findings.
Nearly every Arbour caregiver who treated Rivera in the two years before she died lacked proper qualifications or professional supervision, according to court records.
In 2007 and 2008, Rivera saw two counselors, neither of whom had any professional license. When her parents complained in early 2009, clinic director Edward Keohan suggested that she see Anna Fuchu, who described herself as a psychologist. After a brief evaluation, according to the court filing, Fuchu diagnosed Rivera as bipolar.
Fuchu was not licensed as a psychologist in Massachusetts, despite representing herself as one on Facebook and elsewhere online. Last year she agreed to pay a penalty of $1,000 and promised the state Board of Registration of Psychologists not to use the title.
In May 2009, Rivera’s school said she would need an evaluation by a psychiatrist. Fuchu suggested Rivera see Maribel Ortiz, a licensed nurse practitioner at the clinic, the court documents said.
Ortiz prescribed the antiseizure medication. She had the authority to write prescriptions as long as she had proper supervision from a psychiatrist. Ortiz’s supervisor was a physician but not a board-certified psychiatrist, and she did not have the qualifications to supervise Ortiz, according to state records included in the court filings. The company later told the state that the supervisor was eligible for board certification and planned to take the required exam last fall.
When regulators visited the Lawrence facility in March and April of last year after receiving complaints from Rivera’s family, they found that all clinical therapists were working without the necessary licenses or oversight.
Keohan, the clinic director and a licensed independent clinical social worker, told inspectors that he had been “unaware that supervision was required to be provided on a regular and ongoing basis,” the report said.
Keohan separately acknowledged to the state board that licenses and disciplines social workers that he allowed someone he supervised to act as a social worker though that person was not licensed, and agreed to a two-year probation. He also failed to complete continuing education courses and kept poor patient records, the board found.
Keohan, Ortiz, and Fuchu did not return calls requesting comment for this story.
While investigating the Lawrence clinic, inspectors found that five more Arbour therapists who were not licensed to practice independently went without regular supervision at a clinic in Malden. The company later said that a supervisor had been working with several of those therapists but didn’t chronicle their meetings. The clinic had been cited previously, in 2008, for not keeping records of supervision.
State inspectors also visited Arbour’s Fall River clinic last spring and found that 13 of 27 therapists had refused supervision by the clinic director but were permitted to continue treating patients.
Community mental health clinics serve vulnerable people, including children and adults who may be suicidal. Patient advocates and policy leaders say that intensive management is essential to providing good care in a fast-changing field.
“We have set up a structure that assures oversight so that people, when they are seen by someone who is less experienced and not yet holding that license, that there’s a checks and balance system,” said Barbara Leadholm, former commissioner of the state Department of Mental Health. “I think all of us feel we can sleep well with that system.”
That accountability repeatedly was found to be missing at Arbour clinics. Some industry representatives say that points to a need for better enforcement, not a change in the rules.
Some hospitals have shuttered psychiatric units in recent years, and clinics have closed their doors, too, facing low payments from Medicaid and commercial insurers and high psychiatry costs, said Vic DiGravio, president of the Association for Behavioral Healthcare. Unlicensed employees are more affordable.
“Our members really do depend on a workforce that is, in part, not licensed,” said DiGravio, whose group represents mental health clinics in the state, though not Arbour’s. Those employees are “creating access [to care] that otherwise would not be there at all.”
Universal Health Services is a significant part of the Massachusetts mental health system. Arbour operates nearly one of every five inpatient psychiatric beds licensed in the state.
Arbour executives were previously accused by the federal government of improper billing. In 2004, three affiliated companies agreed to pay the federal government $297,545 to settle claims that they had billed Medicare for services provided by doctors when patients actually had been treated by lesser-paid nurses.
A Barrett Township psychiatrist has been charged with attempting sexual contact with a 13-year-old boy.
The charges against Michael Nathaniel Kessler, 43, a psychiatrist who previously had a practice on Route 447 in Smithfield Township, stem from an investigation that began in early May when an alert mother noticed some suspicious activity on her 13-year-old son’s Facebook account.
After investigating further, she became concerned that someone was contacting her son through Facebook using what appeared to be a fake profile that contained images and information pertaining to young boys in various states of undress.
She contacted police, who referred her to Detective Brian Webbe of the Monroe County Office of the District Attorney, a member of the Pennsylvania Internet Crimes Against Children Task Force.
Webbe, who specializes in computer crimes, assumed control of the child’s Facebook account and began posing as the child.
Kessler, who was using this fake Facebook profile to impersonate a 14- year-old boy, sent Detective Webbe pornographic photographs and videos through Facebook, email, and his cell phone; then solicited Detective Webbe for sex.
Kessler also repeatedly asked for a picture of the 13-year-old boy’s penis.
Through investigation, Webbe was able to positively identify Kessler as the person behind this fake Facebook profile.
Detectives from the Monroe County Office of the District Attorney, along with officers from the Barrett Township Police Department and deputies from the Monroe County Sheriff’s Office, served a search warrant on Kessler’s home on Spruce Cabin Road, seizing several computers and cell phones.
Kessler was arrested and charged with unlawful contact with a minor, obscene and other sexual materials and performances, solicitation and attempt to possess child pornography, and criminal use of a communication facility; as well as a misdemeanor charge of corruption of minors.
He was arraigned by Magisterial District Judge John D. Whitesell of Mountainhome, and taken to the Monroe County Correctional Facility in lieu of $50,000 bail.
His preliminary hearing is scheduled for Thursday, June 27.
He will appear in front of Judge Whitesell on Thursday, June 27, 2013 at 10:45 A.M. for a preliminary hearing.
June 18, 2013
On March 12, 2013, Pennsylvania professional counselor Patricia Anne DeLorenzo permanently and voluntarily surrendered her license to the Pennsylvania Department of State. DeLorenzo pleaded guilty January 23, 2013 to health care fraud, relative to false claims for alcohol treatment services.
Click here for the Department of Justice press release on DeLorenzo’s conviction.
On May 18, 2012, the Louisiana Licensed Professional Counselors Board of Examiners ordered licensed professional counseling Mary C. Dermody to pay a fine of $300 and investigative costs of $330 to the Board, as well as to complete additional continuing education house in the areas of ethics and clinical documentation.
Dermody had provided 35 counseling sessions to two minor clients. In responding to a request from the minors’ father for all clinical records, Dermody submitted handwritten notes for only four sessions and stated that she does not write many notes.
On July 20, 2012, the Louisiana Licensed Professional Counselors Board of Examiners revoked the license of licensed professional counselor June M. Durio for five years. Durio admitted to providing unnecessary counseling services to patients and falsifying documentation regarding counseling services, particularly group therapy sessions, with knowledge that this documentation would be used to submit false and fraudulent claims to Medicare. Durio pleaded guilty April 26, 2012 to one felony count of conspiracy to commit health care fraud.