Fifth Circuit Ruling Affirms that Psychologists are Not immune from Fraud and Abuse Scrutiny

Dr. Sam Smith Hill, III’s 2008 healthcare fraud conviction was affirmed by the 5th Circuit on August 25, 2010 (US v. Hill, No. 09-40749 (5th Cir. Aug. 25, 2010). Found guilty in five counts of healthcare fraud by a jury, Dr. Hill’s indictment alleged that he fraudulently billed Medicaid from 2001 to 2008. Having founded a children’s behavioral clinic in Corpus Christi, Texas that provides psychological services to underprivileged children, the indictment contended that Dr. Hill billed Medicaid for services performed by his Licensed Psychological Associates (LPAs). The Texas Medicaid guidelines prohibit billing Medicaid for services not rendered by a physician. Dr. Hill asserted that he only billed for the work he performed; however, the 5th Circuit disagreed, citing Dr. Hill’s statements to FBI agents claiming “that he knew he was violating Medicaid billing rules, but that the rules were ‘wrong and immoral.'” The court, thus, found there to be “sufficient evidence from which the jury could conclude that the billing included the LPA time,” affirming the lower court’s conviction.

While not given as much attention as other fraud and abuse violations, even mental health professionals must be aware of increased fraud and abuse scrutiny.

For more information, please contact Abby Pendleton, Esq. or Robert S. Iwrey, Esq. at (248) 996-8510 or (212) 734-0128, or visit the Fraud and Abuse specialty page, the Compliance specialty page, or the HLP website.