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Knowledge vs. Wisdom

Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

There’s a difference between being knowledgeable and being wise. You can have knowledge without wisdom, but you can’t have wisdom without knowledge. Uzma Ehtesham, a psychiatrist from Wise, Va., who knew better, was not very wise when she used her knowledge to carry out a healthcare fraud scheme that stole half a million dollars from Virginia Medicaid and Medicare.

Ehtesham obviously possessed knowledge about how to provide mental health care to her patients, however, she did not use this knowledge to make wise choices. She devised a scheme that billed Medicaid and Medicare for individual office visits when she was actually treating patients in groups. (This allowed her to charge the government healthcare programs higher rates.)

Between 2010 and 2016, Ehtesham met with patients in groups of two to four per visit, but she unwisely billed these sessions as if she was meeting with individual patients. She also billed for extensive and costly visits while conducting brief office visits with a patient, such as five to six minutes long. (She apparently saw more than 50 patients per day. How efficient!)

Court documents also show that prescriptions were written in advance of an appointment by office staff. Ehtesham would sign those prescriptions during the brief patient visit. (Five to six minutes doesn’t leave much time for a thorough patient evaluation.) In some cases, the psychiatrist simply had office staff copy over the patient’s vital statistics including blood pressure, pulse, height, and weight to the new visit information sheet. At times, medical staff was not available to track these statistics. (I guess their vitals looked very consistent from brief visit to brief visit.)

Due to her part in the healthcare fraud scam, Ehtesham received $500,000 from Virginia Medicaid and Medicare. The 52-year-old unwise psychiatrist from Wise, Va., (that’s an oxymoron) pleaded guilty to healthcare fraud in November 2020. She was sentenced to two years’ probation and six months of home detention for fraudulently billing Medicare and Virginia Medicaid for services not performed. (If she is wise, Ehtesham will also pay a total of $1million in restitution, fines, and forfeiture to make up for her illegal acts.)

Today’s Fraud of the Day comes from a Department of Justice press release, “Wise Psychiatrist Sentenced for Federal Health Care Fraud,” dated March 17, 2021.

ABINGDON, Va.- Uzma Ehtesham, a Wise, Virginia psychiatrist who defrauded Virginia Medicaid and Medicare by fraudulently billing these programs for services not performed, was sentenced yesterday to two years’ probation, six months of which must be spent on home detention, Acting United States Attorney Daniel P. Bubar and Virginia Attorney General Mark Herring announced today.

Ehtesham, 52, pleaded guilty in November 2020 to a one-count Information charging her with health care fraud.

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