Health Care Fraud
By Bill MimsHealth care fraud in the United States is pervasive and expensive.
Our office’s Medicaid Fraud Control Unit investigates and prosecutes insurance fraud against the federally-funded Medicaid program for indigent Virginians. When a particular healthcare provider is defrauding Medicaid, it is usually defrauding the private insurer as well. Our office has been recognized nationally, as the best state Medicaid Fraud Control Unit, and we have recovered the most money in the history of all state Medicaid Fraud Control Units. (You may have heard about our historic, multi-million-dollar recovery from OxyContin.)
A few weeks ago we successfully prosecuted a psychologist who was stealing from the poor, by billing Medicaid for hours and counseling that didn’t actually exist.
Jeanne M. Watson, who operated Appalachian Psychological Trauma Center in Carroll County, pled guilty to three counts of Medicaid fraud.
As a licensed professional counselor and Medicaid provider, she was billing for more hours of service than were possible in a day. She gave treatments to children and adults that weren’t medically necessary. She said she “accidentally” submitted billings for services not provided. And she fraudulently billed children’s Medicaid numbers.
We jointly investigated the case with the Carroll County Commonwealth’s Attorney, the Department of Medical Assistance Services and the U.S. Department of Health and Human Services Office of the Inspector General. Through our partnership with local, state and federal investigators and prosecutors, we were able to combat fraud. Together, we were able to protect Virginians who otherwise couldn’t afford health care.
Watson returned the $38,130.52 that she stole, and was sentenced to five years probation.
If you would like to report a suspected case of Medicaid fraud or have questions about health care fraud, please contact us at 1-800-371-0824 or MFCU_mail@oag.state.va.us.
Consumer protection is an important statutory duty of the Office of the Attorney General, and our staff can help. In an age of increased consumer issues, we all must continue to be educated and vigilant.