On January 8, 2026, a 62-year-old woman of Crown Point, Indiana, was sentenced to 84 months in prison and ordered to pay $268,746.37 in restitution after pleading guilty to healthcare fraud and aggravated identity theft, United States Attorney Adam L. Mildred announced.
According to court documents, the defendant falsely claimed that she was licensed as a clinical psychologist and falsely represented that she held a Doctor of Psychology degree. In reality, she did not possess these qualifications, but she did have more than ten previous felony convictions.
Using forged and fraudulent documents, the defendant convinced Company A, a mental health services provider in Munster, Indiana, to hire her as a clinical therapist. She also obtained employment at another mental health services provider using false qualifications. While employed there, she conducted appointments with patients, including Indiana Medicaid recipients and children.
Later, the defendant continued to claim she was a psychologist and conducted appointments with patients out of her home, operating under a business name. She continued to fraudulently bill for the services she claimed to provide. As a result of her scheme, she defrauded Indiana Medicaid and Medicare Advantage plans out of hundreds of thousands of dollars.
During the course of the scheme, the defendant stole the identities of three licensed medical professionals. She used their names and license numbers to enroll in Indiana Medicaid and submit fraudulent claims.
“The public relies on the integrity of the healthcare system, and fraud undermines that trust,” said FBI Indianapolis Special Agent in Charge Timothy J. O’Malley. “[This] sentence sends a clear message that healthcare fraud will not be tolerated. The FBI remains committed to working alongside our state and federal partners to protect patients and safeguard the healthcare system.”
Compliance Perspective
Issue
Healthcare organizations are responsible for ensuring that individuals providing services to patients are properly credentialed, qualified, and authorized to practice within their scope. Inadequate verification of credentials, insufficient oversight, and failures in credentialing, supervision, or monitoring processes increase the risk of regulatory noncompliance, improper billing, and harm to patients. Maintaining effective policies, staff education, and routine auditing processes is essential to protect patients, safeguard public healthcare funds, and ensure compliance with federal and state requirements.
Discussion Points
- Review policies and procedures for credential verification, scope of practice, supervision requirements, and documentation standards for all clinical personnel. Policies should outline processes for initial and ongoing verification of licenses and credentials, authorization of personnel to provide reimbursable or covered services, and procedures for reporting and addressing identified discrepancies. Periodic review of these policies—potentially with input from an external compliance or regulatory consultant—can help ensure they remain aligned with current regulatory expectations.
- Provide ongoing education to staff involved in hiring, credentialing, service delivery, documentation, and billing regarding regulatory requirements, scope of practice limitations, and internal reporting mechanisms. Med-Net Academy offers the Staying on Top of Employee Checks course, which addresses the Office of Inspector General Exclusion List, the OIG List of Debarred Contractors, employee licensing and certification verification, and background screening best practices to support regulatory compliance.
- Regularly audit to verify that services billed are supported by accurate documentation and were performed by appropriately credentialed personnel. Audits should assess compliance with licensure requirements, documentation standards, and billing accuracy. Utilizing independent or third-party reviewers for mock audits or focused compliance reviews can offer an objective assessment, identify gaps before they escalate, and support timely corrective action.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*