An Edmond woman pleaded guilty in federal court this week to one count of health care fraud after billing Medicaid for dozens of counseling sessions with children that never took place.
Health Care Fraud in Edmond Oklahoma
Leann Richardson, 48, is a Licensed Professional Counselor who operated through Senses LLC. An online business profile of the company describes Senses as a "counseling, consulting, and life coaching company" that specializes in children's counseling, treating anxiety disorders, eating disorders, sexual and physical abuse, post-traumatic stress disorders, marriage and family therapy, and more.
As part of her counseling practice, Richardson was approved to bill the Oklahoma Health Care Authority (OHCA) for behavioral counseling sessions with Medicaid-eligible children.
According to prosecutors, Richardson billed the OHCA for twice-weekly sessions with children with whom she only met once per week. Additionally, they say, she billed Medicaid for as many as 80 sessions with children during two occasions in which she was not even in the state, but rather on personal trips.Investigators with the Federal Bureau of Investigation (FBI), the U.S. Department of Health and Human Services Office of the Inspector General (HHS OIG), the Oklahoma State Department of Health (OSDH), and the Medicaid Fraud Control Unit of the Oklahoma Office of the Attorney General gathered evidence in the case, and Richardson was charged in the United States District Court for the Western District of Oklahoma.She pleaded guilty on September 17, 2013, to one count of health care fraud, and agreed to pay restitution for the total amount of fraudulent billing. At sentencing, which is scheduled to take place in approximately 90 days, she faces the possibility of 10 years in prison followed by 3 years of supervised release. In addition to restitution, she may be fined up to $250,000.Health care fraud costs the federal government billions of dollars annually--costs that are passed on to taxpayers whose tax dollars fund programs such as Medicare and Medicaid.
False Billing Represents the Largest Form of Healthcare Fraud
Perhaps the largest form of health care fraud is false billing. According to the National Health Care Anti-Fraud Association (NHCAA), false billing includes the following:
- Billing for services never rendered, using either genuine patient information or information collected through identity theft
- Fabricating entire claims or padding legitimate claims with services not rendered or equipment not provided
- Upcoding, or billing for more expensive services or equipment than what was actually provided
- Misrepresenting procedures that are not covered as medically necessary in order to receive insurance payments
- Unbundling services in order to bill separately for each step in a procedure
Federal agencies and United States attorneys are not typically willing to ignore fraud that victimizes the pockets of the U.S. government. Click here to find a fraud defense lawyer who is admitted to practice in the U.S. District Courts of Oklahoma and who has the experience and skill necessary to bring his clients a positive result.