News and Press Releases

Cape Elizabeth Psychologist Sentenced to Eight Months
for Health Care Fraud

FOR IMMEDIATE RELEASE
October 8, 2013

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 Cape Elizabeth, Maine, was sentenced today by Judge
George Z. Singal in the U.S. District Court in Portland to eight months in jail and ordered to pay
restitution totaling nearly $70,000 for 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 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 she only saw the patient once per week.

At the sentencing hearing, Orem-Hough admitted that she submitted false claims to the
insurance companies, but claimed she felt bullied by the insurance companies and entitled to
higher reimbursements.

In imposing sentence, Judge Singal stated that the defendant abused a position of trust
because the insurance companies depended on her to submit truthful claims. He also stated that
she abused her position of trust with her patients because, by using patient names on false claims,
she may have affected their ability to get future reimbursement for services they received if their
insurance plans had limits on the amount of mental health benefits.

U.S. Attorney Delahanty stated that "[t]he sentence in this case sends a strong message
that health care fraud is a serious offense with substantial consequences for professionals who
abuse the system."

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 received from
the patient’s health insurance company.

 

 

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