Counselor Sentenced in $175K Medicaid Fraud Scheme

A $175,609.50 plot to defraud the Missouri Medicaid program got a counselor a years-long sentence for submitting false claims to the government.

According to the Missouri Attorney General, Corrine Dale, a licensed professional counselor falsely billed the state’s Medicaid program for thousands of hours of services she did not provide.

The Medicaid fraud scheme included providing over 24 hours of counseling over 101 separate days. Dale was also accused of falsely billing for behavioral health services for preverbal infants. Additionally, from 2014 to 2015, the counselor allegedly stole the identities of Medicaid participants and falsely billed them.

According to prosecutors, Dale made over $175,000 from the Medicaid fraud scheme by submitting over 3,500 false claims to the Missouri health care program meant to assist those who cannot afford medical services.

Although the judge suspended her prison term and put the counselor on a five-year term of supervised probation, Dale was sentenced to many years in prison for the Medicaid fraud scheme; seven years for each count of Medicaid fraud; fifteen years for each count of identity theft; and another seven years for the charge of receiving stolen property. She will also be required to pay back the $175,609.50 she received for the fraudulent billings in addition to being on probation.

“My office will not tolerate Medicaid fraud in Missouri,” stated the Missouri Attorney General, according to a KMIZ report. “On my watch, those who steal Missouri taxpayer dollars will be prosecuted. I am grateful for the hard work of the Medicaid Fraud Unit to find and return this taxpayer money to the State.”

Medicaid Fraud Schemes

Medicaid fraud schemes and other illegal activities take desperately needed funds from state programs meant for the poor and elderly. In addition, Medicare fraud schemes cost US taxpayers. Medicaid fraud includes submitting false bills, overbilling, as well as kickback schemes.

State and federal agencies have increased efforts to fight Medicare and Medicaid fraud, but these investigations are costly and take extensive time and effort on the part of the agencies. Whistleblowers working for healthcare organizations engaging in Medicaid fraud schemes are a huge help and sometimes the only way that these illegal activities can be stopped. The federal False Claims Act, as well as some state laws, can protect employees who reporting fraud against the government.

Additionally, whistleblowers can receive awards under the False Claims Act. If the legal action against the person or entity perpetrating the Medicaid fraud scheme is successful or there is a settlement, the whistleblower who came forward can receive a substantial portion of the award. Verdicts and settlement agreements can be hundreds of thousands or even millions of dollars for Medicare and Medicaid fraud. Under the False Claim Act, whistleblowers can receive fifteen to 30 percent of that amount.

If you work in the healthcare industry and are concerned about a Medicaid fraud scheme, contact the attorneys at Bradley/Grombacher for help.

Note: Bradley/Grombacher is not representing the plaintiff in this lawsuit.