Thelma “Wendy” Epps was a Licensed Alcohol and Drug Abuse Counselor (LADC) who was enrolled as a participating provider in the Connecticut Medicaid program along with her practice called Miracles to Destiny LLC. But Epp’s focus was not on miracles. She was destined for fraud. In July 2018, the Medicaid program suspended Epps from participating as a provider in the program based on a credible allegation of fraud. Medicaid issued a warning that any attempt to circumvent her suspension by submitting claims for services performed by Epps or Miracles to Destiny through other agencies or other billing numbers would result in termination of her provider agreement. Epps didn’t heed the warning. Fraudsters don’t like ultimatums.
To get around her suspension, Epps entered into an agreement with Dennis Tomczak, a Connecticut LADC who was a participating provider in Medicaid. Per the agreement, Tomczak would bill Medicaid using his Medicaid provider number for psychotherapy counseling services purportedly provided by Epps. In return for Tomczak billing the services, Epps agreed to pay Tomczak 25% of the amount Medicaid paid him, a nice arrangement for no services rendered. But after $330,547 claims were fraudulently paid for by Medicaid, Tomczak got cold feet.
Tomczak expressed concerns to Epps about the number and frequency of services that Epps told Tomczak she was providing, upon which Epps entered into a similar agreement with Shawn Tyson, also a LADC in Connecticut, with a tweak to the scheme. This time, Tyson handed over to Epps his Medicaid provider number and login information to the online portal for submitting claims to Medicaid, which Epps then used to submit claims. Epps submitted psychotherapy service claims that neither Epps nor Tyson had actually provided to Medicaid clients. Medicaid paid Tyson $663,081.32.
On November 8, 2024, Epps pleaded guilty to health care fraud has agreed to pay $1,001,058.43 in restitution to the Connecticut Medicaid program. Her sentencing is scheduled for January 31, 2024.
Great job by the Department of Health and Human Services in this case.
Today’s Fraud of The Day is based on article “Hartford counselor to repay more than $1M to CT Medicaid program after fraud scheme, feds say” published by CT Insider on November 9, 2024.
A Hartford substance abuse counselor pleaded guilty to health care fraud and agreed to repay more than $1 million to the state Medicaid program Friday, the U.S. Department of Justice said in a news release.
Thelma “Wendy” Epps, 59, a licensed alcohol and drug abuse counselor in Hartford, was suspended from participating as a provider in the Connecticut Medicaid program in 2018 because of a fraud allegation. After her suspension, she had another counselor, Dennis Tomczak, submit claims for services to Medicaid that she purportedly provided, the U.S. Attorney for the District of Connecticut Vanessa Avery said in a news release Friday.
