January 5, 2011 (WLS) — A former Chicago woman who claimed her business provided psychotherapy services to Medicare beneficiaries in skilled nursing facilities has pleaded guilty to defrauding Medicare of more than $1.25 million.
Patricia Young, 51, of Newton, Miss., owned and operated a defunct business, Healthy People 2000 Inc., through which she fraudulently claimed to provide psychotherapy services with social workers and physicians, federal law enforcement officials announced.
Young pleaded guilty to one count of healthcare fraud during arraignment Tuesday in U.S. District Court in Chicago, a release from the U.S. Attorney’s office. She faces up to 10 years in prison and a $250,000 fine, with full restitution mandatory.
According to the plea agreement, sometime before 2006, Young and an unnamed physician obtained a Medicare provider number associated with Healthy People, which received third-party payments for claims billed by the doctor.
Under the arrangement, the doctor allowed Young to submit insurance claims for psychotherapy services and Medicare directly reimbursed Healthy People. Young paid a portion of the funds to the doctor, knowing that he had taken no part in therapy sessions. She also had her social workers conduct group therapy sessions with patients and individual therapy lasting no more than 20 minutes.
Between 2006 and 2008, Young submitted false claims to Medicare totaling more than $5 million, as well as false claims of approximately $76,450 to Blue Cross Blue Shield of Illinois, the release said. These claims resulted in payments to Healthy People of about $1.26 million by Medicare and $11,534 by Blue Cross.
Young knew the claims were false because the physician did not provide or supervise services and was not present at the facility when they were being performed; she falsely billed almost all of the services under the most expensive reimbursement code; and she submitted claims for services on days when no service was rendered.
U.S. District Judge Robert M. Dow Jr. set sentencing for July 12.
(Source: Sun-Times Media Wire – Copyright Chicago Sun-Times 2011.)
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Source: http://abclocal.go.com/wls/story?section=news/local&id=7881345
