Waterford Psychologist Medicaid Fraud Case: Absent Therapy and Multiple Family-Member Claims

In the Waterford psychologist Medicaid fraud case, a private-practice owner paid $126,760 to settle allegations that the owner billed for psychotherapy she never provided and submitted family psychotherapy claims when one individual claim was appropriate. For someone who knows the appointments and the billing, that second allegation matters: the government said one family member’s treatment became claims for multiple family members.

The U.S. Attorney’s Office for the District of Connecticut and the Connecticut Attorney General announced the civil settlement on July 3, 2018. The psychologist was licensed in Connecticut, owned a private practice in Waterford and was enrolled as a provider in the Connecticut Medical Assistance Program, which includes the state’s Medicaid program. The payment reimbursed Medicaid and resolved allegations under the federal and state False Claims Acts.

What Medicaid Was Billed For

The government alleged two distinct billing practices covering January 2011 through July 18, 2016. The first was charging Medicaid for psychotherapy services that were not provided. The second was billing family psychotherapy for multiple family members when the provider should have billed individual psychotherapy for one family member.

For a clinician who treated the patient, the appointment calendar is only part of the story. The family-member allegation puts the names on the claims at the center of the comparison: who received individual care, and whom did the practice bill Medicaid for treating?

We see the absurdity in the government’s account: one person’s individual treatment allegedly became a reason to bill for several people. More claims. The same underlying care.

Connecticut’s Medicaid program pays for mental health and counseling services for people who cannot otherwise afford healthcare coverage, as the announcement explains. False claims take money from that purpose. The people whose care the program funds have a stake in whether the treatment on the bill actually happened.

Why Family and Individual Psychotherapy Claims Differ

A later Medicare contractor billing article, revised in April 2026, distinguishes code 90846, family psychotherapy without the patient, from code 90847, family psychotherapy with the patient. The later Medicare guidance also requires distinct time intervals for separate individual and family services on the same date. The Connecticut Medicaid allegation was more specific: the government said this provider submitted family claims for multiple people where individual psychotherapy for one family member was appropriate.

What Are Some Examples of Unethical Billing Practices in Counseling?

Examples of unethical billing practices in counseling include charging for absent therapy, inflating session time and claiming individual care for group work. Separate Connecticut civil settlements addressed allegations of these practices.

In the Behavioral Management LLC settlement announced in February 2021, the government alleged that claims represented 45-minute individual psychotherapy with biofeedback by licensed staff. The alleged services were 20-minute groups without biofeedback, delivered by an unlicensed person.

The claimed duration, individual treatment, biofeedback and professional qualification each told the payer something about the service. According to the government’s allegations, each differed from the work delivered. Calling the whole thing a coding problem loses what a clinician or biller would recognize: the claim described a substantially different service.

The person delivering the Behavioral Management sessions held a bachelor’s degree in social work but was not a licensed Connecticut behavioral health provider. For someone who worked there, knowing who actually led the group could explain a discrepancy that a calendar entry would miss.

In the Children’s Behavioral Therapy settlement announced in January 2020, the government alleged one-hour individual psychotherapy claims for shorter sessions. The Waterford allegations concerned absent services and the use of multiple family-member claims for individual treatment.

First Coast’s Medicare coding guidance, effective January 2025, requires start and stop times or total psychotherapy time. It excludes time spent on a separate evaluation and management service. This later Medicare example shows why the time spent doing psychotherapy matters to billing, alongside the Connecticut cases’ allegations about shorter sessions.

What Evidence Is Needed to Prove Fraud?

Treatment records, claims and an insider’s account of the care are the evidence we examine together: which patient received psychotherapy, which service occurred, who performed it and how the practice represented that work to Medicaid. The important connection is between a particular claim and the encounter it describes.

A clinician’s knowledge of the session can explain why an individual service was appropriate. A billing employee’s view can show which patients and services appeared on the claims. The records of treatment and time give those accounts something concrete to compare. We work with insiders to understand how those pieces fit and where the decisions about billing were made.

The Behavioral Health Investigation Behind the Settlement

The Waterford settlement came out of a broader health care investigation into behavioral health services. The Justice Department identified the investigators as the U.S. Department of Health and Human Services Office of Inspector General, the Medicaid Fraud Control Unit of Connecticut’s Chief State’s Attorney’s Office, and the Connecticut Office of the Attorney General.

A separate counseling case shows the role insiders can play. Former employees brought the whistleblower case behind the Family Workshop Counseling Center settlement. The government alleged that the center used licensed personnel’s credentials to bill Medicare for clinical social work performed by people who were ineligible for reimbursement. The connection to these Connecticut cases is the person behind the claim: an employee can know who delivered care while the bill represents someone else.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. If you know similar billing in another practice, your knowledge of how treatment became a claim is where our conversation starts.

You Know Who Received the Therapy

If you saw individual treatment turn into multiple family claims, or appointments billed without care, speak with our whistleblower experts about the billing you know. We build your strongest Medicaid whistleblower case with you around what happened inside the practice, bring in Medicaid fraud whistleblower lawyers who understand psychotherapy claims, and stay beside you throughout the case.