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Connecticut Psychologist Imprisoned For $1.6 Million Medicaid Scam




Given the current state of the world, it’s understandable that so many people are contending with mental health challenges. Psychologists are often called upon to help individuals process their emotions and resolve their emotional battles. In many cases, psychologists utilize experimentation and observation to interpret how individuals relate to each other and to their environments. Ideally, they help their patients develop strong coping mechanisms.

 

Nearly 56 million Americans seek counseling every year.

 

“In 2022, around 55.8 million adults in the United States received treatment or counseling for their mental health within the past year,” reports Preeti Vankar of Statista, “Such treatment included inpatient or outpatient treatment or counseling, or the use of prescription medication. Anxiety and depression are two common reasons for seeking mental health treatment.”

 

75 year-old Michael B. Pines worked as a psychologist in Glastonbury, Connecticut. Sadly, he was recently proven to be a lot more interested in financial gain that helping his patients with their mental health problems. According to the District of Connecticut branch of the U.S. Attorney’s Office, Pines was just sentenced to 27 months in prison, followed by three years of supervised release. He was found guilty of defrauding Medicaid of more than $1.6 million.

 

Pines owned and operated Michael B. Pines, Ph.D., P.C.

 

At his office, he provided psychotherapy to young children, adolescents and adults. Enrolled individually as a Behavioral Health Clinician provider in the Connecticut Medicaid Program (“Medicaid”), Pines took advantage of his position to illegally bilk the insurance program out of reimbursements.

 

As the U.S. Attorney’s Office reports, Pines submitted fraudulent claims to Medicaid between January 2017 and October 2023. The claims were for psychotherapy services that were purportedly provided to his Medicaid clients. However, his submitted claims were for dates of service when no services of any kind had been provided to the Medicaid clients identified in the claims.

 

Pines was often on vacation during dates he made claims for.

 

In addition to travelling, Pines spent time recovering from surgery or otherwise not working on the dates he submitted claims for. “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,” details the report.

 

Another part of Pines’ scam was to treat multiple Medicaid clients in the same family at the same time. He then billed Medicaid for the group visit as multiple individual claims. This is a practice that he knew was not permitted by Medicaid.

 

Pines used his business bank account for numerous personal expenditures.

 

In total, he defrauded Medicaid of $1,617,679.  He will have to make full restitution including the forfeiture of 16 pieces of jewelry. Pines is currently released on a $250,000 bond. He is required to report to prison on June 24, 2024.

 

Are you an attorney who is currently working a healthcare fraud case? The clinical experts at Allegiant Experts can help you! We coordinate and support courageous whistleblowers that shine lights on fraud, waste and abuse. Contact us today to schedule a complimentary consultation. Please don’t hesitate to give us a call at 407-217-5831. You may also email us at info@allegiantexperts.com.

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