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Sunday, August 18, 2019

ATTORNEY'S OFFICE OF LOUISIANA: Louisiana-Based Licensed Clinical Social Worker Pleads Guilty to Medicaid Fraud Scheme

By Press release submission | Mar 25, 2019


U.S. Attorney's Office for the Middle District of Louisiana issued the following announcement on March 19.

A Louisiana-based licensed clinical social worker pleaded guilty today for his role in a scheme to defraud Medicaid.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Brandon J. Fremin of the Middle District of Louisiana, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Field Office, Special Agent in Charge Eric J. Rommal of the FBI’s New Orleans Field Office and Director Jeff W. Traylor of the Louisiana Attorney General’s Office’s Medicaid Fraud Control Unit (MFCU) made the announcement.

Michael Dan Gaines, 66, of Baker, Louisiana, pleaded guilty to one count of health care fraud. His sentencing has not yet been scheduled by U.S. District Judge John W. deGravelles of the Middle District of Louisiana, who accepted his plea.

Gaines was a supervisory-level licensed clinical social worker at St. Gabriel Health Clinic Inc. (St. Gabriel), which was a federally qualified health center (FQHC) headquartered in St. Gabriel, Louisiana that contracted with the Iberville Parish School Board to provide medical services within the school district. As a FQHC, St. Gabriel could provide primary care services to students as well as services related to the diagnosis and treatment of mental illnesses, provided that such services were medically necessary, among other requirements. As part of his guilty plea, Gaines admitted that he and other St. Gabriel practitioners provided character development seminars and other educational programs to entire classrooms of students during regular class periods. Gaines further admitted that St. Gabriel then submitted numerous fraudulent claims to Medicaid, falsely representing that the practitioners had performed group psychotherapy. In addition, Gaines admitted that to facilitate the fraudulent scheme, he and others falsely diagnosed students with mental health disorders.

According to the indictment, during the relevant time period, St. Gabriel’s claims for group psychotherapy services totaled more than $1.8 million.

Original source can be found here.

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