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Character Counts

Healthcare-8
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

St. Gabriel Health Clinic, of Baton Rouge, Louisiana, was a federally qualified health center (FQHC), contracted with the Iberville Parish School Board, to provide healthcare services to Medicaid recipients within the school district. As a FQHC, St. Gabriel could provide primary care services to students as well as services related to the diagnosis and treatment of mental illnesses, as long as the services provided were medically necessary.

Unfortunately, CEO Victor Clark Kirk, set up the Iberville Parish School contract with a clear pathway for engaging in fraudulent behavior. At the beginning of the school year of 2011, he directed his employees to obtain signed parental consent forms for all students. That allowed Kirk and others to interact with children without having to notify parents for the remainder of the year.

As part of school programs, Kirk set up development sessions labeled “Character Counts!” (any irony here?). He then instructed the clinic practitioners to provide these character development courses during regular class periods. Kirk then had his employees label their classroom gatherings as “group psychotherapy” sessions in an effort to bill Medicaid.

Medicaid doesn’t pay for school-based sessions deemed educational in nature. And the federal government eventually refused payments because students hadn’t been diagnosed as needing mental health help. In turn, Kirk had his clinic intentionally misdiagnose the students with mental health disorders they never showed signs of having which then got Medicaid approval.

From 2011 through 2015, Kirk racked up more than $1.8 million in fraudulent claims for these purported group psychotherapy services. But the money isn’t the real damage. Our system is designed so that services in schools are assigned based on mental health diagnoses. So potentially, a child at Iberville could have been put into a category unnecessarily, therefore affecting how his or her education plan unfolds. Furthermore, children with misdiagnosed conditions in their medical records could cause doctors to overlook a mental illness for which they need actual treatment.

At least Kirk has been stopped. He was found guilty on September 26, 2022 and faces up to 20 years in prison. Hopefully, by the time he gets out, the damage to the students’ medical records will have been reversed.

Great job by the Health Care Fraud Strike Force in this investigation.

Today’s Fraud of the Day is based on an article “A clinic falsely diagnosed kids with mental health disorders. Now its ex-CEO faces prison” published by USA Today on September 26, 2022

A former health clinic CEO was convicted Friday of defrauding Medicaid in a scheme that involved providing fake psychotherapy services and false mental health disorder diagnoses to children, federal prosecutors announced.

Victor Clark Kirk,73,was convicted of conspiracy to commit health care fraud and health care fraud for violations that occurred while he was the head of St. Gabriel Health Clinic Inc.

 

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