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Calculator and stethoscope on paperwork

Psychologists are supposed to help those who are struggling by providing counselling. Unfortunately, some healthcare companies and professionals choose to betray the trust of their clients and use their position to commit Medicaid fraud. (Which ironically causes the need for those defrauded to require more counselling to heal from the damage caused. It’s a vicious cycle.)

Alabama resident Heidi Robertson pleaded guilty to one count of conspiracy to commit healthcare fraud for filing false claims with the Alabama Medicaid Agency. Robertson was the primary insurance billing official for Capstone Medical Resources LLC, which offered psychological counselling services to the Birmingham area.

Capstone Medical Resources LLC defrauded the state of Alabama out of more than $1.5 million dollars by charging for services that were never provided. Former Birmingham psychologist Sharon D. Waltz was the owner of the facility and pleaded guilty in 2019 to defrauding Medicaid.

Robertson admitted to submitting claims on behalf of the company using Medicaid information she stole from the children of friends and relatives. (Sounds like Robertson may be in need of counselling after deluding herself into thinking she could get away with this scheme.) She would bill Medicaid claiming the company performed counselling services that never took place.

Robertson was paid a 10 percent commission by Waltz for all claims paid by Medicaid from 2016 to 2017. (I wonder if the commission was worth the prison time she’s now facing.)

The Alabama Medicaid Agency became suspicious and launched an investigation into Capstone after an audit revealed a significant increase in their billings. Their claims for counselling services increased from $99,000 in 2015 to more than $2 million in 2017. (Even the most successful businessmen can’t make “miracles” like that happen.)  

The Attorney General’s Medicaid Fraud Control Unit reviewed the Alabama Medicaid Agency’s findings and launched a subsequent investigation. Both investigations concurred that the majority of Capstone’s claims from 2016 to 2018 were fraudulent. (It didn’t take much investigation to realize Capstone made up about ninety percent of their earnings.)  

Alabama’s Attorney General Steve Marshall issued a statement condemning the fraud as an illegal and immoral scheme which allowed for a few selfish individuals to profit at the expense of children in need of help. He reiterated the state’s commitment to protecting at risk-youth and their dedication to detecting and prosecuting fraud.

Today’s Fraud of the Day comes from an article, “Birmingham Psychology Clinic Employee Pleads Guilty To Fraud,” published by MSN on July 29, 2020.

BIRMINGHAM, AL — A former employee of a Birmingham area psychology clinic that defrauded the Alabama Medicaid Agency of at least $1.5 million by billing for counseling services that were never provided pleaded guilty Wednesday. Heidi Robertson, 35, pleaded guilty to one count of conspiracy to commit healthcare fraud for her role in filing false claims to the Alabama Medicaid Agency.

Robertson was employed as the primary insurance billing official for Capstone Medical Resources, LLC. The owner of the facility, former Birmingham psychologist Sharon D. Waltz, pleaded guilty in 2019 to defrauding Medicaid.

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Larry Benson
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.