Counseling Crisis

An adorable little toddler boy sits in his mother's lap in a volunteer run medical clinic and sticks out his tongue for the nurse. She is unrecognizable as she leans in to look down his throat.

Medicaid recipients are some of the most vulnerable among us. Things are even worse for those needing mental healthcare, which is one of the toughest specialties for accessing treatment. In the world of fraud, it’s especially appalling when a practitioner would breach the trust of mental health patients – in this case, kids – who are Medicaid recipients.

That’s what happened in Birmingham, Ala., where a psychologist pleaded guilty to defrauding the state’s Medicaid program of at least $1.5 million – all of which she will have to repay as part of the plea agreement.

The 50-year-old woman from Birmingham acknowledged filing false claims through Capstone Medical Resources, which provided individual and group counseling services for at-risk youth.

According to the case brought by the U.S. Attorney for the Northern District of Alabama, Jay Town, an audit by the Alabama Medicaid Agency showed that Capstone’s billings increased from $99,000 in 2015 to more than $2.2 million in 2017. (She didn’t think anyone would notice?!)

The Medicaid fraud investigation found that most of the company’s claims filed between 2016 and 2018 were fraudulent. The psychologist submitted and directed her employees to submit claims for counseling that never occurred and, in some cases, for people who never received services at all.

“The greed of this defendant deprived mental health care to many at-risk young people in Alabama, with the focus on profit rather than the efficacy of care,” Town said. “The costs are not just monetary but have social and health impacts on the entire Northern District.”

The psychologist was a prosecution witness in a separate fraud case in 2016 in which the CEO of the former Birmingham Health Care was sentenced to 18 years in prison for defrauding the state Medicaid program of $13.5 million, according to reports. (That explains why she didn’t serve time.)

In 2016 the Alabama Attorney General’s Medicaid Fraud Control Unit conducted 62 Medicaid fraud investigations, returned 23 indictments, and 11 civil settlements, recovering more than $17 million.

Today’s Fraud of the Day comes from the article, “Birmingham psychologist pleads guilty to defrauding Alabama Medicaid Agency,” published Aug. 19, 2019 in the Alabama Political Reporter.

Sharon D. Waltz agreed Thursday to plead guilty to a one-count charge of defrauding the Alabama Medicaid Agency by filing false claims for counseling services that were not provided.

U.S. Attorney Jay E. Town, U.S. Department of Health and Human Services-OIG Special Agent in Charge Derrick L. Jackson, and Alabama Attorney General Steve Marshall announced the guilty plea on Thursday.

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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.