Shelby Township Psychologist Charged with Billing for Unperformed Psychological Tests

An indictment was unsealed today charging  psychologist Paul L. Smith, PhD, 54, most recently practicing in Shelby Township, Michigan, with fraudulently billing Blue Cross Blue Shield of Michigan (BCBSM) for neuropsychological and psychological testing that was never performed, U.S. Attorney Matthew Schneider announced today. In total, according to the indictment, BCBSM lost approximately $5,000,000 as a result of Smith’s false claims. Smith is scheduled to be arraigned in federal court tomorrow afternoon.

Schneider was joined in the announcement by Acting Special Agent in Charge Timothy Waters of the FBI’s Detroit Division and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office.

The indictment alleges that from January 2015 to February of 2018, Smith submitted approximately 1,700 false claims for neuropsychological testing (CPT Code 96118) and 140 false claims for psychological testing (CPT Code 96101).  As an example of excessive and unnecessary billing, the indictment alleges that Smith billed BCBSM for allegedly providing neuropsychological testing on 21 occasions for a single patient within a single year, each claim involving 24 hours of professional service.  BCBSM paid Smith approximately $61,000 based upon false claims on behalf of that patient.    In total, according to the indictment, BCBSM lost approximately $5,000,000 as a result of Smith’s false claims.

An indictment is only a charge and is not evidence of guilt. The defendant is entitled to a fair trial in which it will be the government's burden to prove guilt beyond a reasonable doubt.  The case was investigated by Special Agents of the FBI and HHS.  The case is being prosecuted by Assistant U.S. Attorneys John Engstrom and Shankar Ramamurthy.