Stressed Out

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Psychiatrists are supposed to help their patients cope with stress, not cause it. An article published by the Fairfield Patch tells about how a Connecticut psychiatrist and her husband caused quite a bit of stress for their patients, as well as their state’s Medicaid program by bilking the Connecticut Medical Assistance Program (CMAP) out of more than $750,000.

The story details that the psychiatrist and her husband co-owned a psychiatry business that had offices in two locations. From January 2010 through July 2012, the couple managed to submit bogus claims for services that were not necessary or not provided, then concealed the overpayment. They upcoded the false claims—a common fraudulent practice that uses specific codes to reflect more expensive procedures or services—then submitted to CMAP for reimbursement. (Further research revealed that the defendants received $768,171 as a result of their illegal actions.)

Additional details show that the psychiatrist was able to carry out the scam by scheduling her Medicaid patients in 15 or 30 minute increments. She then double, triple and sometimes quadruple booked her patients. (And as you might guess, these appointments were not for group sessions.) The professional multitasker also used a code that allowed her to bill each patient as if she were seeing them for 75 to 80 minutes, when in reality, she was only spending five to 10 minutes with each patient, if she saw them at all.

State investigators identified 113 days over a period of two years where the psychiatrist billed CMAP for more than 24 hours of service. Then the Department of Social Services (DSS) determined that the couple attempted to conceal from auditors the fact that there were computer databases containing data that proved the claims were false and that the couple altered patient files. (The story also states that this practice continued even after the state investigation began.)

The psychiatrist and her husband have agreed to pay $400,000 to CMAP. Under the agreement with DSS, the psychiatrist has been suspended from participating in CMAP for three years.

These fraudsters took advantage of their Medicaid patients because they were an easy target. (The criminals were counting on beneficiaries not checking their bills, which revealed multiple charges for services that were not necessary, nor provided in some cases.)Congratulations to the state’s Attorney General for going after this couple and putting a stop to their scheme.

Source: Today’s ”Fraud of the Day” is based on a New Haven and Fairfield-based psychiatrist and her husband who will pay $400,000 to settle a civil lawsuit that accused the couple of participating in a long-running scheme to submit false claims to a state Medicaid program.

Dr. Ashwini Sabnis, a licensed psychiatrist enrolled as a provider in the Connecticut Medical Assistance Program, and her husband, Saurav “Sam” Mohanty, co-owners of Brighter Concept, Inc., were accused of participating in an illegal scheme that resulted in the submission of false claims for services that were not provided and claims that were “upcoded,” using a higher-paying code to reflect the use of a more expensive service, procedure or device than was actually used or was medically necessary.

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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.