Second employee pleads guilty of defrauding Alabama Medicaid Agency of at least $1.5 million

Alabama News

BIRMINGHAM, Ala. (WIAT) — A second person has pleaded guilty after defrauding the State Medicaid Agency by filing false claims for counseling that were never provided, totaling to at least $1.5 million.

Heidi Robertson, 35, of Birmingham, pleaded guilty to one count of conspiracy to commit healthcare fraud for her role in filing false claims to the Alabama Medicaid Agency (AMA) for individual and group counseling services for at-risk youth while she was employed as the primary insurance biller for Capstone Medical Resources, LLC. According to the Attorney General office, the owner of the facility, former Birmingham psychologist Sharon D. Waltz, pleaded guilty in 2019 to defrauding Medicaid of $1.5 million and is awaiting sentencing in federal court.

An investigation was initiated by the Program Integrity Division of the AMA after an audit showed that billings submitted by Capstone for counseling services had increased from $99,000 in 2015 to more than $2 million in 2017. The Program Integrity Division referred its findings to the Attorney General’s Medicaid Fraud Control Unit after Waltz submitted falsified records during the Program Integrity Audit.

A follow-up investigation was then conducted by the Medicaid Fraud Control Unit and the Office of Investigations (OI) of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). This investigation determined that the majority of claims submitted by Capstone from 2016 through 2018 were fraudulent.

Robertson’s role in the scheme included submitting claims using the Medicaid identifications of the children of friends and family members for counseling services that never took place. Waltz paid Robertson a 10% commission for all claims paid by Medicaid. Robertson was employed by Waltz from 2016 through late 2017.

“The defendant’s actions demonstrated reckless disregard for at-risk youth,” U.S. Attorney Prim Escalona said. “The U.S. Attorney’s Office will continue to work with our law enforcement partners to protect the members of our community that are the most vulnerable, our children.”

Attorney General Steve Marshall said the “defendant engaged in an illegal and immoral scheme to profit at the expense of children in need by claiming payment for services that were never provided.  As Attorney General, I stand committed with the U.S. Attorney and the Department of Health and Human Services to punish those who plunder the public treasury and betray the at-risk youth they were entrusted to serve.”

In a warning to others who may think about committing fraud at other’s expense, Special Agent in Charge for the OIG of the HHS, Derrick L. Jackson, gave this warning.

“Let this be a warning to medical billers around the State of Alabama that if you facilitate the submission of fraudulent claims, you will be held accountable for your actions,” Jackson said.  “Together with our partners at both the state and federal level, the OIG will continue to identify and hold accountable those responsible for such schemes.”

The OIG for the HHS, the Alabama Attorney General’s Medicaid Fraud Control Unit, and the Program Integrity Division of the AMA investigated the case. Assistant U.S. Attorney J.B. Ward and Assistant Attorney General Bruce Lieberman, working as a Special Assistant U.S. Attorney, prosecuted.


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