Acting US Attorney Matthew T. Drake announced on July 22, 2025, that the US Attorney’s Office for the Eastern District of Missouri had reached a $501,556 civil settlement with a Missouri psychiatrist to resolve allegations under the False Claims Act (FCA).
The settlement addresses allegations that, between Jan. 1, 2019, and May 31, 2024, the psychiatrist submitted false claims to both Medicare and Missouri Medicaid. Specifically, he falsely represented that he had provided face-to-face psychotherapy to patients—including on dates when he was out of town—and billed for services which were provided by other practitioners. He was a part-owner of a behavioral health company that operated a psychiatric consulting firm in St. Louis, Missouri.
Under the settlement, $250,778 will be paid in restitution, which is doubled under the FCA. The agreement includes no admission of liability.
Separately, in April 2025, the psychiatrist pleaded guilty to making false statements in federal healthcare-related matters. In his plea, he admitted to submitting claims for payment to Medicare, Medicaid, and private insurers for in-person services he did not perform, including while he was outside Missouri or out of the country. Sentencing is scheduled for August 11.
“Holding healthcare professionals accountable for submitting false claims for financial gain is crucial for maintaining public trust and ensuring that critical resources are appropriately utilized,” said Linda T. Hanley, Special Agent in Charge with the United States Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG, the US Attorney’s Office, and our law enforcement partners will continue to collaborate our efforts to protect the integrity of the Medicare and Medicaid programs.”
Compliance Perspective
Issue
Healthcare providers are expected to ensure that all claims submitted to Medicare and Medicaid accurately reflect the services provided. Submitting claims for services that were not delivered or properly documented can lead to civil penalties under the False Claims Act. Each individual item or service billed counts as a separate claim, and penalties can be significant. Staff should be trained to recognize and report potential compliance issues, and facilities must foster a culture that encourages reporting without fear of retaliation.
Discussion Points
- Review your policies and procedures related to billing, documentation, and the prevention and reporting of false claims. Ensure they clearly outline responsibilities, procedures, and protections for staff who report suspected misconduct. Ensure your compliance plan includes protocols for investigating and remediating billing concerns.
- Make sure staff receive training on your compliance and ethics policies as part of the onboarding process and at least once a year after that. Include information on what could be considered a false claim and how to recognize common billing issues. For staff involved in Medicare billing, provide guidance on using the Triple Check Process to help ensure claims and documentation are accurate before submission.
- Periodically perform audits to ensure all staff are aware of compliance and ethics concerns and understand their responsibility to report any potential compliance and ethics violations to their supervisor, the compliance and ethics officer, or via the anonymous hotline. Audit to ensure that the Triple Check Process is being followed each month before claims are submitted to Medicare, and that any identified irregularities are corrected.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*