South Portland Psychologist Pleads Guilty to Health Care Fraud
Contact: James W. Chapman, Jr.
Assistant U.S. Attorney
Tel: (207) 780-3257
Portland, Maine: United States Attorney Thomas E. Delahanty II announced that Dr.
Carole Orem-Hough, Ph.D., age 55, of South Portland, pled guilty in the U.S. District Court in
Portland, before Judge George Z. Singal, to committing health care fraud.
According to court records, from September 2008 to September 2011, Orem-Hough was
a licensed psychologist doing business as Casco Bay Psychotherapy in South Portland. During
that time, she provided counseling services to patients, many of whom were insured by private
health insurance plans. Orem-Hough admitted that she defrauded Aetna, Anthem Blue Cross
and Blue Shield, Harvard Pilgrim and OptumHealth Behavioral Solutions, by submitting claims
for counseling sessions that never occurred. In many cases, Orem-Hough billed insurance
companies for two counseling sessions per week when Orem-Hough only saw the patient once
per week. Orem-Hough told one patient that she double-billed Aetna because the company
reimbursed her about half of what she received from other companies.
U.S. Attorney Delahanty stated that the fraud loss in this case is over $69,000 and
involved false claims with respect to almost 50 patients. Orem-Hough faces up to ten years in
prison and a fine of up to $250,000. She will be sentenced after completion of a pre-sentence
investigation report by the U.S. Probation Office.
This case was investigated by the Federal Bureau of Investigation after a patient noticed
and reported billing discrepancies in an Explanation of Medical Benefit Statement from the
patient’s health insurance company.
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