Chief State’s Attorney Patrick J. Griffin announced on February 17, 2026, that a 66-year-old Connecticut woman was sentenced to three years in prison, execution suspended, with five years of conditional discharge for defrauding Medicaid by submitting fraudulent claims for services she did not perform and allowing unlicensed individuals to provide behavioral health services. The defendant paid $55,410.69 in restitution on the day of sentencing, and was ordered not to serve as a Medicaid provider during the five-year conditional discharge period.
By pleading guilty to two program-related felonies, the defendant is also subject to mandatory exclusion as a healthcare provider from certain federally funded health programs pursuant to federal and state laws and regulations.
An investigation by Inspectors of the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney determined that between December 2018 and April 2020, the defendant, a licensed behavioral health clinician, and owner of a counseling practice in Meriden, billed for psychotherapy services that were not rendered. Evidence obtained during the investigation showed that she was not meeting with clients as reported; however, she was submitting claims to the Department of Social Services for payment. In addition, she utilized unlicensed employees to meet with clients and then billed as though licensed, qualified services had been provided. The investigation concluded that the defendant fraudulently billed Medicaid and received $55,410.69 in payments to which she was not entitled.
The case was investigated and was prosecuted by the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney with assistance from the Department of Social Services Office of Quality Assurance, the US Department of Health and Human Services Office of the Inspector General (HHS-OIG), and the New Britain Police Department.
Compliance Perspective
Issue
Healthcare providers participating in Medicaid and other federally funded healthcare programs are required to ensure that services billed for reimbursement are accurately documented, medically necessary, and performed by appropriately licensed and qualified individuals acting within their scope of practice. Billing for services not rendered, misrepresenting the credentials of individuals providing care, or permitting unlicensed personnel to perform services requiring licensure may result in significant civil and criminal liability, exclusion from federal healthcare programs, and reputational harm.
Discussion Points
- Review policies and procedures related to documentation standards, billing compliance, scope of practice, supervision requirements, and credential verification. Policies should clearly outline processes for confirming licensure at hire and on an ongoing basis, defining which services may be performed and billed by specific credentialed staff, and addressing discrepancies or identified compliance concerns. Periodic policy review—potentially in collaboration with a regulatory compliance consultant—can help ensure alignment with federal and state requirements and industry best practices.
- Provide ongoing education and training to appropriate staff regarding documentation accuracy, scope of practice limitations, and Medicaid billing requirements. Training should reinforce that services must be performed as documented and billed only when supported by accurate records, and that staff are responsible for reporting compliance concerns through established channels. Med-Net Academy offers Employee Recordkeeping Requirements and Education and The Importance of Proper Licensure – A Case Study, which provide practical guidance on maintaining compliance with staffing, licensure, and documentation standards.
- Conduct routine and targeted audits to verify that services billed are supported by contemporaneous documentation and were performed by appropriately licensed personnel. Audits should include periodic review of personnel files, licensure status, supervision records, and claims submissions. Organizations may benefit from utilizing independent reviewers or mock survey resources to provide objective assessments, identify vulnerabilities, and support timely corrective action before deficiencies escalate into enforcement matters.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*