Thursday, December 22, 2016

Connecticut Office Manager Pleads Guilty to Health Care Fraud Charges for Billing for Psychotherapy Services Using Social Worker's Provider Number Who Did Not Provide Services

Mental health audits and prosecutions are on the rise in “behavioral health” which includes a wide variety of health care providers who provide care on an outpatient basis. These providers include psychiatrists, psychologists, licensed clinical social workers, licensed marriage and family therapists, licensed professional counselors, and licensed alcohol and drug counselors.  

Managers are often charged in health care fraud cases and a recent case relates to a manager's alleged participation in fraud and abuse in outpatient behavioral health. On December 14, 2016, office manager Maurice Sharpe of Connecticut waived his right to indictment and pleaded guilty before U.S. District Judge Bolden to one count of health care fraud. The facts relate to billing for psychotherapy services provided by unlicensed individuals, using another provider's Medicaid number or billing for services not provided. 

According to court documents and statements made in court, in February 2011, Mr. Sharpe and his mother, Patricia Lafayette, and another individual, formed Family First Community Support Services, LLC, a social services agency. Mr. Sharpe was the office manager. It was alleged that Ms. Lafayette and another person approached Anne Charlotte Silver, a licensed clinical social worker who owned and operated Silver Counseling Services, LLC. Ms. Lafayette and the other individual allegedly proposed that she and the other individual would bill Medicaid for psychotherapy services using Ms. Silver’s Medicaid provider number.   

The services were allegedly either performed by unlicensed individuals or not performed at all. The proposed deal was that Ms. Silver keep 25 percent of the proceeds, and paid the remaining 75 percent to Ms. Lafayette and the other individual. Ms. Lafayette and Ms. Silver previously pleaded guilty to health care fraud for their roles in this arrangement. This means that Mr. Sharpe plead after them knowing they very well may testify against him.  

As part of his plea, Mr. Sharpe admitted that he submitted claims to Medicaid for psychotherapy services that falsely represented that Ms. Silver had personally provided the services. Mr. Sharpe also admitted that he submitted hundreds of claims to Medicaid for psychotherapy services purportedly provided to his family members, including his children and nieces and nephews, when no such services were ever provided. 

Mr. Sharpe admitted that he also assisted in preparing records that falsely documented the nature and extent of the services received by his family members. A sentencing date has not been scheduled. 

charge of health care fraud carries a maximum term of imprisonment of 10 years but sentencing is a complex process and a guilty plea will give him credit for acceptance of responsibility. Generally, his counsel will also prepare a sentencing memorandum focusing on mitigating circumstances and other factors under the sentencing guidelines in order to obtain the most favorable sentence possible. 

Posted by Tracy Green, Esq.
Phone: 213-233-2260
Green and Associates, Attorneys at Law


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