Doubly Unqualified

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The State of Alabama ‘s Medicaid agency requires mental health counselors to meet specific licensure requirements before providing services to underprivileged patients and submitting claims for reimbursement. The owner of an Alabama counseling business was doubly unqualified to participate in the Medicaid program for these two reasons: she was not licensed and did not provide the services claimed.

While the owner and eight counselors who worked at the counseling center that provided services to at-risk youth all held a master ‘s degree or above pertaining to counseling, Alabama ‘s Medicaid agency required that they be supervised by a qualified clinician. (The woman, who owned the business, was aware of this requirement and signed off on the agreement with the health care program even though eight of the counselors were not properly supervised by a licensed clinician as required by Medicaid.)

The counselors submitted their session notes to the office manager who then filed the claims with Medicaid, knowing they were responsible for providing an accurate account of the counseling session. At this point, the qualified clinician, a licensed psychologist ,was supposed to sign off on the counseling sessions, approving of any documented action taken. (However, the licensed psychologist did not have an agreement with the other counselors, just the owner of the business, so she did not sign off on claims submitted by the eight.)

Medicaid reimbursed the counseling business, then the owner paid her counselors about 20 percent of the payment as compensation. (This amount was their salary as they did not receive one from the counseling business.) The state ‘s Medicaid Fraud Control Unit investigated the counseling service after the owner failed to provide appropriate documentation during a routine claims audit. (That ‘s because there probably wasn’t any documentation to be found.)

The 43-year-old business owner pleaded guilty to one count of conspiracy to commit health care fraud. She was sentenced to five months in prison to be followed by five months of home confinement for defrauding the Alabama Medicaid Agency. The counseling business owner was also ordered to pay restitution of $29,601.

Apparently, this woman obtained most of her referrals through schools and juvenile courts. Unfortunately, she not only victimized the state ‘s most vulnerable citizens, she also took advantage of taxpayers who pay into the health care program. Congratulations to the Alabama Attorney General ‘s Office for doubling down on this double-crossing fraudster.¬† (Great work!)

Source: Today’s “Fraud of the Day” is based on an article entitled, “Dothan counselor sentenced for $30K Medicaid fraud case,” published by the Dothan Eagle on April 17, 2017.

A Dothan woman has been sentenced to five months in prison after, according to court records, she defrauded the Alabama Medicaid Agency and the federal government by billing for counseling of at-risk youth that never took place.

Catrina R. Copeland 43, of Dothan, received a sentence of five months in prison and five months of home confinement, according to the Alabama Attorney General’s Office for the Middle District of Alabama.

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.