A Colorado behavioral health provider has been charged with orchestrating a large-scale Medicaid fraud scheme involving thousands of dollars in claims for therapy services that were never delivered. According to the Colorado Medicaid Fraud Control Unit (MFCU) and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), the defendant routinely billed for counseling sessions that were fabricated, duplicated, or performed by unlicensed staff.
Investigators allege that the provider submitted claims for hour-long psychotherapy appointments on dates when clients were either hospitalized, incarcerated, or had moved out of state. In multiple cases, the children whose identities were used had not attended the clinic in years. Former employees told investigators they were instructed to “fill out sessions retroactively” to hit billing targets, even if the clients had no active treatment plan on file.
The scheme first drew attention when Colorado’s Medicaid analytics system flagged a series of suspicious billing patterns, including identical service times across dozens of patients and abnormally high daily therapy volumes. One day reflected 18 hours of billed sessions — an impossibility that suggested systematic manipulation rather than clerical error. Additional inconsistencies emerged when client attendance logs, appointment calendars, and location data were cross-referenced with submitted claims.
Further investigation revealed that the provider had also billed Medicaid for services allegedly performed by clinicians who either did not hold valid licenses or were no longer employed by the facility. In one instance, claims were submitted under the National Provider Identifier of a therapist who had left the practice nearly a year earlier.
“This case is a clear reminder that fraud doesn’t always involve complex schemes — sometimes it’s the deliberate exploitation of vulnerable patients and taxpayer-funded programs,” said Colorado Attorney General Phil Weiser. “Robust verification tools and real-time data monitoring are essential to detecting these abuses early.”
When investigators executed a search warrant, they uncovered pre-filled progress notes, unsigned treatment plans, and billing templates designed to automate claims with minimal documentation. Officials say this evidence demonstrates intent to deceive and sustain the scheme over multiple years.
The provider has been charged with Medicaid fraud, forgery, theft, and attempting to influence a public servant. Colorado MFCU has referred several associated cases for potential civil recovery, and additional charges may follow as investigators review linked claims submitted through affiliated clinics.
Today’s Fraud of the Day comes from reporting by the Colorado Attorney General’s Office and The Denver Post regarding Medicaid provider fraud in 2025.
