Saturday, February 21, 2009

Marriage Family Therapist: Attorney Comments On Recent Case Of Billing For Services Not Provided And Overbilling

On February 20, 2009, Carla Gireaux, a licensed marriage and family therapist, was arraigned in Superior Court on charges filed by the Los Angeles County District Attorney’s Office. Ms. Gireau was a former contract therapist with the Los Angeles County Department of Mental Health. Ms. Gireaux is accused of allegedly billing more than $500,000 to the county for mental health services never rendered.

As attorneys who protect peoples' rights under the Constitution, please remember that a felony complaint contains allegations that a defendant has committed a crime. Every defendant is presumed innocent unless proven guilty in court.

The case has been assigned to the Public Integrity Division of the DA’s Office. Prosecutors allege that between October 2002 and December 2007, Ms. Gireaux submitted false claims to the county for services never provided. In other cases, she allegedly provided services but over-billed for more sessions than were provided or continued billing after services ended. In submitting false claims for services not rendered, she allegedly forged the signatures of parents on three occasions.

Ms. Gireaux was charged with multiple counts of grand theft, forgery and other felony tax charges. She is being held on $500,000 bail. If convicted as charged, she faces a maximum term of eight years and four months in state prison.

Commentary: The case brings up many lessons and reminders for professionals who bill the government and insurance companies. Even if you know that you would never commit “fraud” by billing for services not provided – there are things to remember.

First, with the government budget and economic crisis, there is great pressure on government and insurance companies to cut their expenses by focusing on fraud and for seeking reimbursement of funds paid for “overbilling” or billing for services not provided. You need to be extra cautious when billing these entities and set up compliance plans, hire an outside attorney to ensure you are following the rules and conduct periodic audits so that any billing errors will be treated as “mistakes” and not “fraud.”

Second, record keeping is important. We have seen many cases where the alleged overbilling is frivolous and non-existent or is based on the fact that there was bad. Remember to keep excellent records. See our prior post on record keeping:

Third, review the billing of other professionals in your office or business. We have seen cases where someone else in the office billed for services not provided. One of our doctor clients was charged criminally when someone in charge of a family counseling program pulled files randomly and wrote notes and billed Medi-Cal in an effort to help the office make more money and to make her appear to be a better office manager. We got the charges dismissed at preliminary hearing and extensive investigation – but if there had been a compliance program and periodic audits of the chart, all of this might have been discovered and prevented.

Fourth, if you or your office has engaged in overbilling, create a plan of action. There are times where services were provided but not billed for or were billed at an upcoded level. Consult an outside attorney (which is protected by the attorney-client privilege unlike consultants or accountants) and see what options are available. If the money is paid back before a government or insurance audit and a record is created of how these errors occurred, it will be much less likely that there will be a criminal fraud case. Having a plan can lessen your personal stress and help you take control of the situation.

Fifth, consider the consequences to a professional license in your strategic plan. If the overbilling or lack of oversight of the office was due to mental health, personal or addiction issues, address these and get your regulatory board or bureau involved if appropriate. Certain boards have diversion programs. If there are other issues, address them and remember that being proactive can help show the regulatory agency that you are essentially an honest professional who made mistakes but have sought to solve them.

This is one of the reasons why having a plan for returning overbilled amounts, rebilling or creating a compliance plan is helpful since it shows lack of intent to defraud. Everyone will want to know how you or your business reacted when the billing errors were discovered. If there was a cover-up, that could be used as evidence that there was intent to defraud. If there was an investigation and plan for taking care of these issues, it is consistent with mistakes and lack of oversight.

We have assisted many professionals in these types of cases. You need to engage in acts that show there was not intent to defraud and that when you discovered the overbilling, you did something about it. It may be financially painful, but criminal charges can destroy your practice and professional life. Take some steps to address these issues at an early stage. If it’s not an early stage, do your best to take care of it since the statute of limitations in these cases is long (4 years from date of discovery of the overbilling in state cases).

Any questions or comments should be directed to: Tracy Green is a principal at Green and Associates in Los Angeles, California. They focus their practice on the representation of licensed professionals and businesses in civil, business, administrative and criminal proceedings and investigations.


DISCLAIMER: Green & Associates' articles and blog postings are prepared as a service to the public and are not intended to grant rights or impose obligations. Nothing in this website should be construed as legal advice. Green & Associates' articles and blog postings may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents and contact their attorney for legal advice. The primary purpose of this website is not the commercial advertisement or promotion of a commercial product or service and this website is not an advertisement or solicitation. Anyone viewing this web site in a state where the web site fails to comply with all laws and ethical rules of that state, should disregard this web site.

The information provided on this website is for informational purposes only. It is not intended to create, and does not create, a lawyer-client relationship with Green & Associates, Attorneys at Law. Sending an e-mail to Tracy Green does not contractually obligate them to represent you as your lawyer, or create any type of client relationship. No attorney-client relationship will be formed absent a written engagement or retainer letter agreement signed by both Green & Associates and client and which specifies the scope of the engagement.

Please note that e-mail transmission is not secure unless it is encrypted. E-mail messages sent to Ms. Green should not include confidential or sensitive information.