Oh Behave


According to Medicaid.gov, the government benefits program is the single largest payer for mental health services for adults and children in the United States. The owner of an Oklahoma-based behavioral health counseling service and her son, who was employed by the business, took advantage of this fact and submitted approximately $770,000 in bogus claims. (Their false claims were related to Medicaid-eligible children for whom they allegedly provided behavioral health counseling services.)

Over the course of about two-and-a-half years, the mother-son duo devised and carried out three schemes that defrauded Medicaid through their counseling business. The first scheme involved submitting claims for periods of time when the children they were supposedly providing counseling services for were being transported either between home, school or the counseling offices. The second scheme was related to the submission of psychosocial rehabilitation service claims that were greater than the 90-minute time period allowed per child per day. The last scheme involved claims for services that were not actually provided, were provided in groups of two or more children, or were provided for less time than billed.

After being indicted on 151 counts of health care fraud, the mother, 60 and son, 26 ended up pleading guilty to three counts of health care fraud linked to submitting false claims. They agreed to reimburse Medicaid by paying restitution of $769,578.38. They are both facing up to 10 years in prison, three years of unsupervised release and a $250,000 fine for each count.

It’s ironic that these two fraudsters provided behavioral health counseling services. I’m guessing that their sentences could possibly include behavioral counseling. (It will be interesting to see how they handle a dose of their own medicine.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Mother, son plead guilty to defrauding Medicaid out of nearly $770,000” posted on KFOR.com on January 5, 2017.

OKLAHOMA CITY – A mother and a son pleaded guilty to defrauding Medicaid out of nearly $770,000.

Yesterday, officials say Deborah Gray, 60, and her son, Keith Gray, II, 26, both of Oklahoma City, pleaded guilty to three counts of health care fraud in connection with submitting false claims to Medicaid for behavioral health counseling services.

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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.