A Florida man was sentenced on January 28, 2026, to one year and one day in prison for causing psychotherapy sessions to be fraudulently billed to New Hampshire Medicaid.
The 55-year-old Miami resident was previously convicted in 2015 of conspiracy to commit healthcare fraud and related offenses in the Southern District of Florida. Following that conviction, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) placed him on the Exclusion List, which identifies individuals who are prohibited from receiving payment from federal healthcare programs, including Medicaid.
Despite this exclusion, in March 2022, the defendant began working for a telehealth mental health provider based in New Hampshire. He provided services billed to New Hampshire Medicaid patients, knowing he was barred from participation. He also caused the provider to submit claims for counseling services that were not properly provided, including instances in which he requested—and later received—a patient’s assistance with personal tasks. As a result, he admitted that he caused New Hampshire Medicaid to pay approximately $173,998 based on false and fraudulent claims.
The defendant pleaded guilty on October 23, 2025, to one count of healthcare fraud. At sentencing, he was ordered to pay $173,998.83 in restitution.
Separately, the US Attorney’s Office previously reached a resolution with the telehealth provider and its owner to resolve a parallel civil matter. Under that settlement, they paid $300,000 to resolve allegations that they violated the False Claims Act by improperly billing Medicaid for services provided by the defendant while he was excluded from the Medicaid program.
Compliance Perspective
Issue
Healthcare organizations must ensure that all individuals providing services are properly authorized, credentialed, and compliant with applicable federal and state regulations. Inadequate oversight, insufficient verification, or gaps in monitoring can result in improper billing, regulatory noncompliance, and financial or civil liability for the organization. Maintaining robust policies, providing ongoing staff education, and conducting routine audits are essential to mitigate risks to patients and the organization. These measures also support quality care and regulatory compliance.
Discussion Points
- Review policies and procedures for screening prospective and current employees, contractors, and service providers against the OIG List of Excluded Individuals and Entities (LEIE). Policies should include initial and ongoing checks, documentation standards, and follow-up steps for potential matches. Organizations may consider engaging external compliance consultants to evaluate processes, perform focused reviews, and strengthen policies to align with regulatory expectations.
- Ensure that staff involved in hiring, credentialing, compliance, and billing receive ongoing training on exclusion requirements, including how to access and use the OIG Exclusion List, the risks of employing an excluded individual, and proper documentation practices. Med-Net Academy offers the course Office of Inspector General (OIG) Exclusion List, which reviews examples of excluded individuals, the consequences of hiring an excluded person, and how to verify exclusion status.
- Conduct periodic audits to ensure that exclusion checks are performed consistently and properly documented for all new hires and current personnel, including contractors and telehealth providers. Audits should also verify that no claims have been submitted for services provided by excluded individuals. Organizations may benefit from engaging an independent reviewer or consultant to conduct mock audits, identify gaps in the screening process, and assist in developing corrective action plans to strengthen compliance and reduce future risk.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*