Limited license psychologist convicted of fraud
The fraud would have continued if not for the suspicions of an alert coworker.
Our Corporate and Financial Investigations department received a complaint from a fully licensed psychologist in reference to a coworker's suspicious billing practices. The complaining psychologist reported the coworker wasn't collecting copayments and was filing claims for services he didn't provide.
An investigation by CFI and the Michigan State Police resulted in search warrants at the defendant's home and two offices in Grand Rapids and Greenville. Evidence collected at these locations revealed the defendant, a limited license psychologist, submitted claims for services he didn't deliver and filed claims for face-to-face consultations that were actually phone calls to patients. He also indicated he was being supervised by a fully licensed psychologist when, in fact, he was not being supervised at all.
The defendant went to great lengths to cover his scheme. He created fictional medical records to reflect services provided, and even met with patients in the late evening hours, asking them to lie to investigators if they were ever questioned.
The defendant pled no contest to two counts of health care fraud and was sentenced in Kent County Circuit Court to probation. He was ordered to pay $121,890.25 in restitution to Blue Cross Blue Shield of Michigan.