DALLAS (WBAP/KLIF News) — Two licensed professional counselors from the Dallas-Fort Worth area have pleaded guilty to their roles in a massive health care fraud scheme that involved bribes, unnecessary medical treatment, fraudulent billing, and the falsification of medical documents to fraudulently bill the federal government through Worker Compensation Programs to the tune of more than $9.5 million.
According to U.S. Attorney John Parker of the Northern District of Texas, the lead defendant in the case Larry Washington of Desoto, pleaded guilty to one count of conspiracy to commit health care fraud. He was sentenced to 6 1/2 years in federal prison and ordered to pay approximately $7.7 million in restitution. Washington ran businesses known as AAA Mental Health, LLC, Mind Spa, Inc., Solutions Health and Rehabilitation, and Convergence Emergence Diversion.
Another licensed professional counselor, Henrietta Price of Cedar Hill, was given six months home confinement, three years of probation and must pay almost $200,000 in restitution. She also pleaded guilty to one count of conspiracy to commit health care fraud. Price provided counseling services at Mind Spa, Inc. and also treated patients at her own company, Lifeline Counseling.
Through his businesses, Washington provided patients with counseling, pain management, chiropractic services, physical therapy and massage services. He sought out and recruited his patients who were former postal and VA employees who had suffered on-the-job injuries that prevented them from returning to work. Washington knew that even though these individuals had once suffered a work-related injury, their injuries were not severe enough to warrant continued OWCP payments.
Twenty-one claimants, four doctors or medical providers, a senior claims examiner at DOL, a claims representative, and a medical provider’s employee were charged in the scheme. All but two defendants have pleaded guilty to their roles in the scheme.
In total, the defendants were able to collectively fraudulently bill the federal government through the OWCP for more than $9.5 million and receive more than $8.7 million in government payments based on their fraudulent billing. The DOL made approximately $11.4 million in payments to these claimants for their compensation and medical services. The government anticipates that as a result of the convictions it will also prevent the payment of an estimated $11 million in future payments.
Prosecutors say the scheme began with former or current U.S. postal employees or Veterans Affairs employees who claimed they had been injured during the course of their work duties. Each of these government workers claimed they had suffered an on-the-job injury which prevented them from returning to work.
Under OWCP, these “claimants” could receive workers’ compensation payments and paid medical treatment…if a qualified doctor deemed the medical services necessary and if the injury prevented the claimant from working.
A DOL claims examiner would review the claim and either approve or reject it. In certain cases if an on-the-job injury caused permanent damage a claimant could have received a “scheduled award” – a lump sum payment to compensate that individual for their injury. These awards often amounted to several hundred thousand dollars. These “claims representatives” either charged claimants a percentage of any paid claim or a flat rate fee. When doctors or other medical providers treated the claimants, they could bill OWCP for their work.
The investigation was led by the U.S. Postal Service Office of Inspector General and the Department of Labor with assistance from Internal Revenue Service Criminal Investigation, U.S. Treasury Office, Social Security Administration Investigations Unit, and the U.S. Department of Veterans Affairs.
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