Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million
For Immediate Release
U.S. Attorney's Office, District of Connecticut
Vanessa Roberts Avery, United States Attorney for the District of Connecticut, Roberto Coviello, Special Agent in Charge of the U.S. Department of Health and Human Services, and Robert Fuller, Special Agent in Charge of the New Haven Division of the Federal Bureau of Investigation, announced that MICHAEL B. PINES, 75, of Avon, waived his right to be indicted and pleaded guilty today before U.S. District Judge Sarala V. Nagala in Hartford to health care fraud.
According to court documents and statements made in court, Pines is a psychologist who owned and operated Michael B. Pines, Ph.D., P.C., located in Glastonbury. Pines provided psychotherapy to young children, adolescents, adults, and he was enrolled individually as a Behavioral Health Clinician provider in the Connecticut Medicaid Program (“Medicaid”).
Between January 2017 and October 2023, Pines submitted and caused to be submitted fraudulent claims to Medicaid for psychotherapy services that were purportedly provided to his Medicaid clients. Specifically, Pines submitted claims for dates of service when no services of any kind had been provided to the Medicaid clients identified in the claims, including when he was traveling, on vacation, recovering from surgery, or otherwise not working. He also submitted claims when an appointment had been canceled, when the claimed client was in the hospital, when he had stopped treating the claimed client, and when the claimed client had never been his client. In addition, when Pines treated multiple Medicaid clients in the same family at the same time, he billed Medicaid for the group visit as multiple individual claims, a practice that he knew was not permitted by Medicaid.
Through this scheme, Pines defrauded Medicaid of $1,617,679. As part of his plea, Pines has agreed to pay full restitution. He also has agreed to forfeit several jewelry items that were seized during the investigation.
Judge Nagala scheduled sentencing for May 6, at which time Pines faces a maximum term of imprisonment of 10 years.
Pines is released on a $250,000 bond pending sentencing.
This investigation has been conducted by the U.S. Department of Health and Human Services, Office of the Inspector General (HHS-OIG) and the Federal Bureau of Investigation.
This case is being prosecuted by Assistant U.S. Attorney David T. Huang.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS.
Updated January 31, 2024
Health Care Fraud