SEATTLE PSYCHOLOGIST SENTENCED TO PRISON
FOR FALSELY BILLING MILITARY MEDICAL INSURANCE PROGRAM
Man Billed for Patients he Did Not Treat, Appointments that Never Occurred
DAVID CELIO, 63, of Seattle, Washington was sentenced today in U.S. District Court in Seattle to twelve (12) months and one (1) day in prison for Health Care Fraud. CELIO pleaded guilty November 17, 2006 and on March 28, 2007 agreed to settle civil charges against him for the false bills by paying the United States $510,264. CELIO maintains offices in Everett, Oak Harbor and Mukilteo. At sentencing today U.S. District Judge Marsha Pechman told CELIO, “the raw facts are that you got money that you weren’t entitled to,” and in making up notes to support false claims “you created medical histories that were not true and that can affect patients for years.”
According to records filed in the case, CELIO billed for therapy sessions with patients that never took place. For example, CELIO saw the brother of a patient, one time, as part of a family counseling session. However, after that session, CELIO billed TRICARE – a federal health care program for families of active military members and reservists – for twenty-five sessions relating to therapy with the brother. Two months after the one time he saw the brother, CELIO submitted a written request to TRICARE for further treatments, noting symptoms and diagnoses for the brother and reporting on his progress in therapy. After submitting this fraudulent request for additional treatment, CELIO continued to submit claims to TRICARE for the brother. This is just one example of CELIO submitting claims for therapy sessions that never occurred, or for sessions after the person had ceased to be a patient. CELIO also illegally billed for sessions handled by phone and billed for a higher level of service than occurred. CELIO did not keep separate notes on each patient but instead made incomplete notes on multiple patients in a single spiral notebook. When TRICARE asked for treatment notes for claims that had already been submitted, CELIO did not provide his notes from the spiral notebooks. Rather, he made up new notes, including notes for sessions that in fact had never occurred, but for which he had previously submitted claims. The Washington State Department of Health is currently investigating CELIO for possible disciplinary action.
In asking that CELIO serve prison time, Assistant United States Attorney Susan Loitz noted that this type of fraud increases health care costs, and could lead to cuts in benefits. In her sentencing memo Loitz wrote, “The military families that rely on the TRICARE program are families that sacrifice greatly. They deserve generous health care benefits that remain secure. Fraud committed against TRICARE puts their benefits in jeopardy.”
“Over 9 million active, reserve and retired military members and their families depend on health care services that are delivered and billed appropriately,” said Rick Gwin, Special Agent in Charge, Defense Criminal Investigative Service (DCIS), Western Field Office. “Billing for services not rendered or unauthorized services is not only stealing from the American taxpayer but also from the honorable men and women who serve our nation. The DCIS, along with its partners from TRICARE (the uniformed services health care program) will vigorously pursue investigations of medical providers who commit these crimes."
The case was investigated by the Department of Defense, Defense Criminal Investigative Service. The criminal case was prosecuted by Assistant United States Attorney Susan Loitz and TRICARE was represented in the civil case by Assistant United States Attorney Peter Winn, as part of the U.S. Attorney’s Office efforts to combat Health Care Fraud.
For additional information please contact Susan Loitz at (206) 553-7970 or Emily Langlie, Public Affairs Officer for the United States Attorney’s Office, at (206) 553-4110.