Medical insurance can be complicated for both the patient and the medical provider. This can cause inconsistencies in the reporting of medical services performed by healthcare professionals. However, these inconsistencies can result in serious legal problems, including charges for white collar crimes, for medical providers. One psychologist is learning this the hard way and is now facing Medicaid insurance fraud charges in Georgia.

Prosecutors are accusing the psychologist of fraudulently billing Medicaid for services that were never performed. The Georgia Attorney General’s Office claims that the psychologist billed more than $250,000 worth of fraudulent claims. The psychologist allegedly received payments for the reported services in question between late February 2011 and mid-November 2013.

The authorities have prosecuted the psychologist for white collar crimes based upon the fact that she could not provide proper documentation for the reported services provided to patients during this time period. Medicaid requires medical professionals to maintain documentation for services billed to the program for reimbursement. The defendant was enrolled in a program known as Georgia Medicaid’s Psychological Services Program, which provides counseling for patients younger than 21 years of age that are eligible for Medicaid benefits.

On the other hand, the psychologist may have a reasonable explanation as to why she was not able to produce the proper documentation of the services she claimed to have provided in her reports submitted to Medicaid. There could be a variety of legal defense strategies the defendant psychologist could employ in the court case in Georgia. Being well-prepared to present a strong defense in court could result in having the insurance fraud charges reduced or possibly dismissed.

Source: wrcbtv.com, “Ringgold psychologist accused of Medicaid fraud after accepting”, Beth Burger, Sept. 18, 2015

Please see here for additional blog entries.