On May 29, 2013, the Maine Board of Examiners of Psychologists issued a formal reprimand to psychologist Carole Orem-Hough. Orem-Hough agreed as well to surrender her license for at least one year. This action was the result of a complaint filed by a former patient of Orem-Hough, who reported that the psychologist disclosed that she was double billing the patient’s insurance and was double billing all of her patients who were insured by either Aetna or Harvard Pilgrim as they did not reimburse her what she felt she should be reimbursed.
August 7, 2013
July 16, 2013
ANDERSON, Ind. — An Anderson psychologist charged with health care insurance fraud is on a federal hold in Marion County Jail.
Bruce E. Jones, 65, was scheduled for trial this week on charges of fraud and illegal possession of firearms, but claimed to be ill and did not show up to court. Jones requested a continuance of the trial, which was not granted. U.S. Marshals arrested Jones shortly after on Tuesday, according to U.S. Attorney General Joe Hogsett’s office.
Jones is accused of fraudulently billing at least two health care benefit programs for counseling services that were not actually provided to patients in excess of $100,000, according to a federal grand jury indictment in May 2012.
Additionally, the indictment alleges that Jones had in his possession more than two dozen firearms, including rifles and handguns, and more than 1,000 rounds of ammunition.
In May 2012, a spokesman for the U.S. attorney’s office said Jones was believed to be in the Pacific Northwest and was considered a fugitive, but Jones returned a message left on his cellphone by The Herald Bulletin.
Jones said he was out of state visiting friends and was not aware of any indictment, warrant issued for his arrest or that he was considered a fugitive, and indicated that he was on his way back to Indiana.
Three years ago, FBI agents searched Jones’ home as part of an investigation into his billing practices.
Jones served time in prison in the 1980s for insurance fraud and selling drugs. He was barred from possessing firearms and ammunition because of those convictions, according to the indictment.
His counseling practice is located at his home west of the Anderson city limits.
On June 10, 2013, Florida psychologist William Kale was convicted of two counts of health care fraud for submitting false expenditure reports to the sate Medicaid program. He faces up to ten years in prison when sentenced.
Federal prosecutors accused Kale, along with other former executives of the health maintenance organization WellCare Health Plans Inc., of defrauding the Medicaid program of nearly $30 million. Kale is the former vice president of Harmony Behavioral Health Inc. (a wholly-owned subsidiary of WellCare).
Prosecutors stated that WellCare took Medicaid money with the understanding that if it did not use 80 percent of the funds for behavioral health services, the difference was to be returned to the state. Prosecutors said defendants including Kale conspired to inflate reports of what they actually spent, in order to reduce the amount they had to return.
December 26, 2011
Lawrence Suess has been charged with 14 counts of medicaid fraud following an investigation of his billing practices.
Seuss owns and operates out of the Western Kentucky Center for Psychiatric Medicine.
The indictment alleges that Doctor Suess intentionally submitted false claims to Medicaid by claiming he provided individual therapy sessions that paid at higher rate than the sessions he actually performed between January of 2005 and September of 2007.
Doctor Seuss is scheduled to appear in a Hopkins County court on January 10th. He could face up to 70 years in prision if convicted.
June 9, 2010
Medical board charges psychiatrist Alban Coghlan with numerous prescription violations, practicing with expired license
On February 12, 2010, the Vermont Board of Medical Practice issued a Specification of Charges on psychiatrist Alban J. Coghlan for numerous counts of unprofessional conduct.
The Board’s document states that Coghlan failed to renew his license in a timely manner when it expired on November 30, 2004. He renewed it a week later. It was later determined that he continued to practice on the lapsed license.
In August 2006, the Board received information from the state Medicaid Fraud Control Unit that Coghlan had submitted bills to Medicaid for six patients he provided service to during the period when his license was lapsed, for which he had been reimbursed $342.03 by Medicaid.
The Board then opened a complaint against Coghlan. In response to the complaint, Coghlan stated to the Board that once he realized his license had expired, “I closed my practice, didn’t see patients, or write any prescriptions.” However, the Board found this to be false, based on information the Board received in February 2007 from the state Medicare-Medicaid agency, which showed that Coghlan had also submitted bills the Medicare for nine patients to whom he had provided medical services during period his license had lapsed, and for which he’d received reimbursement of $442.14 from Medicare.
Records acquired from Coghlan by the Board and a Drug Enforcement Administration (DEA) agent by subpoena showed that Coghlan saw 23 patients over a three-day period during which his license was lapsed.
The Board/DEA investigation additionally found that Coghlan:
- Permitted 9,500 tablets of a controlled substance to be ordered through his DEA number, delivered to his office and diverted to a family member’s personal use from 2002 through 2007;
- Prescribed controlled substances to an immediate family member on at least eight occasions from 1999 through 2001;
- On at least 45 occasions between 1999 and 2007, Coghlan prescribed controlled substances to an immediate family member without setting forth the medical basis for each prescription and without conducting and/or documenting a medical history or examination;
- Prescribed controlled substances to two non-family members without setting forth the medical basis for each prescription and without conducting and/or documenting a medical history or examination;
- Ordered 100 tablets of Vicodin through his own DEA number, which he diverted for his own use and storing the controlled substance Ambien in his office without keeping records of receipt, administration, prescription or professional use of the drug.
Source: Specification of Charges In re: Alban J. Coghlan, M.D., Docket No. MPC 112-0806, State of Vermont Board of Medical Practice, February 12, 2010.
March 25, 2010
A federal appeals court has upheld psychiatrist Maria Carmen Palazzo’s fraud convictions.
Palazzo was indicted June 14, 2007 on 55 counts of health care fraud and false documentation associated with a clinical trial of Paxil in children and adolescents, conducted at New Orleans’ Touro Infirmary. She also defrauded the Medicare program by submitting false and fraudulent invoices to Touro for consulting and medical director services.
On April 16, 2008, she was convicted of 39 of the counts.
On January 14, 2009, Palazzo was sentenced to 87 months in federal prison, restitution of $655,260.97 to the Medicaid and Medicare programs and three years of supervised release following her prison sentence.
In her appeal of the conviction, Palazzo claimed jurors heard insufficient evidence to support her convictions for defrauding the Medicare program by billing for services she didn’t provide.
But a three-judge panel from the 5th U.S. Circuit Court of Appeals rejected that argument this week affirmed her convictions.
Federal prosecutors say Palazzo submitted false invoices to Touro Infirmary as part of the scheme. She was sentenced last year to 87 months in prison and ordered to pay more than $655,000 in restitution.
Source: “N.O. psychiatrist’s fraud convictions upheld,” Associated Press, March 25, 2010; “Local psychiatrist indicted for fraud associated with mentally ill patients and children in clinical trials,” press release of the the United States Attorney’s Office, Eastern District of Louisiana, June 14, 2007 and “New Orleans doctor sentenced to seven years, 3 months in federal prison for healthcare fraud violations,” press release of the the United States Attorney’s Office, Eastern District of Louisiana, January 14, 2009.