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On December 19, Michael Lonski, a Greenwich psychologist, was sentenced to a 27-month prison term and three more years of supervised release for a scheme to defraud Medicaid. Lonski submitted over 80,000 claims from 2014 to 2019, and in calendar year 2017 he submitted claims for services on all but one day—including holidays and weekends. He billed for more than 12 hours of services on 901 dates, and for more than 24 hours of services on 60 dates. The scheme totaled over $2.6 million in losses, including to the Connecticut Medicaid program and to Medicare. 

More recently, on January 31, psychologist Michael B. Pines of Avon, CT pleaded guilty to defrauding Medicaid of over $1.6 million. He submitted claims for psychotherapy services to children, adolescents, and adults—most of which were not rendered to the Medicaid beneficiaries listed on the claims. These claims included dates of service when he was traveling, recovering from surgery, on vacation, or otherwise not working. Some claims were submitted for dates of service when the beneficiary canceled their appointment, Pines no longer treated the beneficiary, or the beneficiary had never received his services at all. In addition to paying restitution, Pines currently faces up to ten years in jail. 

It should go without saying that behavioral health clinicians must ensure that claims are submitted to federal and state healthcare programs only for services duly rendered. Practitioners must also ensure that services are properly documented according to the programs’ requirements.

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