July 16, 2009
LOCAL PSYCHOLOGIST SENTENCED FOR FRAUD
(CORPUS CHRISTI, Texas) - A Corpus Christi area psychologist has been sentenced to five years of probation and six months house arrest for defrauding Medicaid, United States Attorney Tim Johnson and Texas Attorney General Greg Abbott announced today. Chief United States District Judge Hayden Head handed down the sentence against Sam Smith Hill III, 61, a licensed psychologist with a professional office in Corpus Christi and further ordered him to pay $48,739 in restitution to Medicaid and a $40,000 fine.
Hill was convicted by a federal jury’s verdict in June 2008 on six counts of health care fraud for defrauding the Texas Medicaid program. Hill was sentenced to five years of probation and six months of house arrest on each of six counts of conviction for submitting bills to Medicaid under his Texas Provider Number (TPI) for psychological services he claimed to have provided when, in fact, the services had not been provided by him. The court also order Hill to complete 150 hours of community service and to submit to financial surveillance by the United States Probation Department. Each of the six sentences are to be served concurrently.
During his June 2008 trial, the United States proved that Hill billed Medicaid for Psychological Testing conducted by psychological associates hired by Hill to conduct the testing. Under Medicaid regulations, psychologists could not bill for the services performed by others and psychological services provided by psychological associates, regardless of physician or licensed psychologist supervision, are not benefits of the Medicaid program.
The trial evidence revealed that this investigation began in 2004, when the Medicaid Fraud Control Unit received an investigative case referral concerning Hill. The investigation uncovered that Hill hired individuals with Master level degrees in psychology to administer psychological testing but that Hill billed Medicaid as if he had performed the tests himself. In addition, Hill was using un-paid students from his classes at Texas A&M University Corpus Christi to administer psychological testing. Undisputed testimony at trial was that the associates administered between 95 to 100 percent of the psychological tests for defendant. The Texas Medicaid Manual for the years in question states that psychologists cannot bill for the services of others and that psychiatric services provided by a psychological associate, regardless of physician or licensed psychologist supervision are not a benefit of the Medicaid program. Hill was interviewed by agents from the Medicaid Fraud Control Unit and the FBI in August 2007 about his billing practices. Hill’s Medicaid billings continued thereafter and three counts for Medicaid billings in 2008 were included in the original indictment and three additional post-indictment billings were included in the superseding indictment. These counts concerning Hill’s conduct in 2008 are the counts of which the jury convicted Hill.
Hill was convicted on June 30, 2008, of knowingly violating a longstanding Medicaid rule that expressly and unequivocally prohibited him billing for testing work of his associates. No exceptions existed in that rule.
Hill billed the Medicaid program for tests administered by his LPAs at times when he was not immediately available to provide assistance and direction because he was not present in the same office, building or facility when and where the service were provided. In addition, Hill billed the Medicaid program for the testing of his LPAs as if he had done the work himself using the CPT billing procedure code for testing by licensed psychologists.
The court has permitted Hill to remain free on bond pending the imposition of his six-month house arrest.
The investigation leading to the criminal charges was conducted by the FBI and the State of Texas Office of Attorney General - Medicaid Fraud Control Unit, Corpus Christi Division. Special Assistant United States Attorney Rex G. Beasley and Assistant United States Attorney Julie K. Hampton prosecuted the case.
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