Albany Psychiatric Nurse Practitioner Fraud: Therapy Bills Without Therapy

An Albany psychiatric nurse practitioner agreed to pay $188,850 to resolve a civil fraud case involving Medicare bills for psychotherapy she never provided and misuse of pandemic relief funds. She admitted both in the civil agreement. For someone inside a psychiatric practice, the case reaches familiar ground: what the clinician actually did, what the bill said, and what happened to money intended for patient care.

The Justice Department announced the civil agreement alongside separate criminal guilty pleas on June 30, 2025. The criminal case concerned false health care claims and unlawful amphetamine prescribing. The civil agreement concerned Medicare psychotherapy claims and Provider Relief Funds.

What the Guilty Plea Said About the Missing Care

According to the Justice Department’s account of her healthcare fraud guilty plea, the practitioner submitted claims to health care benefit programs in New York for services she never provided. Those services included psychotherapy and evaluation and management. The department reported approximately $163,640 in losses from that false billing.

The practitioner had formerly lived in Albany. She was living in Florida while claiming to practice in Albany, according to the same announcement. A practice address, a patient’s name and a service description can make a bill look complete while the treatment it represents is missing.

For a billing employee or clinician, we connect the claimed service and the work behind it with the claim and the payer.

Prescriptions in a Former Patient’s Name

In the separate unlawful drug distribution guilty plea described by the Justice Department, the practitioner admitted issuing amphetamine prescriptions for nonmedical purposes and outside the usual course of professional practice. The department identified Adderall as an example of the controlled substance involved.

From November 2018 through May 2023, she issued 108 prescriptions in the name of someone who had not been her patient since 2016. She issued them at the request of a relative of the former patient. The treatment relationship had ended. The prescribing had not.

For someone handling refill requests, we examine how a request reached the prescriber and what care stood behind it.

The DEA’s Tactical Diversion Squad investigated the case.

The Civil Agreement Included Relief Money

The practitioner admitted using $48,670 in Provider Relief Funds for impermissible purposes in the separate civil settlement agreement. Her civil admissions covered both that misuse and Medicare claims for psychotherapy she never provided.

The Coronavirus Aid, Relief, and Economic Security Act had allocated that money to healthcare providers for costs associated with the COVID-19 pandemic.

We see the same abuse from both directions: charge for care never delivered, then misuse money meant to keep care available.

Psychotherapy Billing Depends on Separate Work

Psychotherapy and evaluation and management describe different work, and the distinction matters when a practice bills for both. First Coast’s Medicare coding instructions effective January 1, 2025 required start and stop times or total psychotherapy time, excluding time spent on evaluation and management.

Those instructions distinguish psychotherapy billed on its own from psychotherapy added to a separately identifiable medical service. The time supporting the psychotherapy charge belongs to the psychotherapy. A service description on a claim has to connect to the work recorded for that patient, rather than simply to the length of an appointment slot.

This is why a psychiatric practice’s scheduling, clinical and billing records need to be read together. The difference between them can explain an absent service or an additional charge that the clinician’s account does not support.

The billing mechanics also help an insider recognize a more concealed version of the same problem, when some care occurred but the bill added work that did not.

When the Bill Adds Care the Clinician Did Not Provide

In its American Psychiatric Centers settlement announcement, the Justice Department alleged that the company, doing business as Comprehensive Psychiatric Services, used psychotherapy add-on codes with evaluation and management visits for psychotherapy that was absent or inadequately documented.

What Evidence Is Needed to Prove Fraud?

For absent psychotherapy, the evidence connects a specific paid claim to the patient encounter, the professional who supposedly provided the service and what actually happened. Our work is to build that connection with the person who understands the practice.

A clinician may know which services were delivered. A scheduler may know whether the claimed encounter took place. A billing employee may see a charge for psychotherapy that was never provided. An accounting employee may understand how relief funds were spent. Each view answers a different question raised by this case.

You do not have to explain the entire operation before speaking with us. The part you understand may connect the practice’s records to a false government claim. We work with you to assess that connection and develop the case around what the evidence shows.

How Much of a Settlement Does a Whistleblower Get?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. For someone who knows that a practice’s Medicare bills describe care never delivered, that is a reason to speak with our whistleblower experts about the claims and your knowledge of them.

You Know What Happened in the Practice

If you saw therapy added to bills, prescriptions disconnected from care or relief money diverted from its purpose, talk with our whistleblower experts about what you know. We build the case with you, bring in mental health billing whistleblower lawyers and stay beside you through the pursuit of a recovery.