According to officials, an employee who was working at Capstone Medical Resources, LLC, a psychology clinic in Birmingham area, pleaded guilty on Wednesday, July 29, to defrauding the Alabama Medicaid Agency (AMA) of about 1.5 million dollars. The fraud involved billing the Alabama Medicaid Agency for certain counseling services, which the clinic never provided.
Heidi Robertson, the former employee of the clinic, was charged with one count of conspiracy related to committing health care fraud and her part in the filing of false claims. Heidi’s profile was of primary insurance billing official at the clinic and she was employed there from 2016 till late 2017.
It is worth mentioning here that Sharon D. Waltz, the clinic’s owner and former psychologist, pleaded guilty to fraud against Medicaid in 2019.
How was the fraud carried out?
An investigation was started by AMA’s Program Integrity Division when in an audit, it was noticed that Capstone Medical Resources, LLC submitted counseling services related billing that rose from 2015 figure of $99,000 to $2 million by 2017.
These findings were referred to the Medicaid Fraud Control Unit (MFCU) of the Attorney General’s office after Sharon D. Waltz submitted falsified records during the audit by Program Integrity Division.
The Fraudulent Claims
A second investigation was carried out by MFCU and the Office of Investigation of U.S. DHHSO (Department of Health and Human Services Office) of Inspector General. During this investigation, it was found that the majority of all claims that the clinic submitted during the 2016 to 2018 time period were fraudulent.
Heidi played the role of submitting claims through Medicaid identification of kids of family members and friends for various counseling services. Still, such counseling never happened, as per the report published by the Office of the U.S. Attorney.
The investigation also revealed that Sharon D. Waltz paid Heidi 10% commission for claims which were paid by Medicaid.
According to Prim F. Escalona, U.S. Attorney, the defendant’s misdeed highlights complete disregard for our at-risk children and youth. Escalona also mentioned that the U.S. Attorney’s Office is determined to work in tandem with its law enforcement partners and protect our children, who are the vulnerable members of the community.
