Louisiana-Based Licensed Clinical Social Worker Pleads Guilty to Medicaid Fraud Scheme
A Louisiana-based licensed clinical social worker pleaded guilty today for his role in a scheme to defraud Medicaid.
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Brandon J. Fremin of the Middle District of Louisiana, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Field Office, Special Agent in Charge Eric J. Rommal of the FBI’s New Orleans Field Office and Director Jeff W. Traylor of the Louisiana Attorney General’s Office’s Medicaid Fraud Control Unit (MFCU) made the announcement.
Michael Dan Gaines, 66, of Baker, Louisiana, pleaded guilty to one count of health care fraud. His sentencing has not yet been scheduled by U.S. District Judge John W. deGravelles of the Middle District of Louisiana, who accepted his plea.
Gaines was a supervisory-level licensed clinical social worker at St. Gabriel Health Clinic Inc. (St. Gabriel), which was a federally qualified health center (FQHC) headquartered in St. Gabriel, Louisiana that contracted with the Iberville Parish School Board to provide medical services within the school district. As a FQHC, St. Gabriel could provide primary care services to students as well as services related to the diagnosis and treatment of mental illnesses, provided that such services were medically necessary, among other requirements. As part of his guilty plea, Gaines admitted that he and other St. Gabriel practitioners provided character development seminars and other educational programs to entire classrooms of students during regular class periods. Gaines further admitted that St. Gabriel then submitted numerous fraudulent claims to Medicaid, falsely representing that the practitioners had performed group psychotherapy. In addition, Gaines admitted that to facilitate the fraudulent scheme, he and others falsely diagnosed students with mental health disorders.
According to the indictment, during the relevant time period, St. Gabriel’s claims for group psychotherapy services totaled more than $1.8 million.
The case was investigated by HHS-OIG, the FBI and the MFCU, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Louisiana. Trial Attorneys Justin M. Woodard and Jared Hasten of the Fraud Section and Assistant U.S. Attorney Jessica M.P. Thornhill of the Middle District of Louisiana are prosecuting the case.
The Medicare Fraud Strike Force is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.