Family Workshop Counseling Center: Alleged Use of Licensed Names on Claims for Someone Else’s Work

In the Family Workshop Counseling Center fraud case, the company and its owner agreed to pay $350,000 to resolve allegations that they billed Medicare under licensed clinical social workers’ credentials for services provided by people ineligible for reimbursement. If you work in counseling, the distinction is familiar: who treated the patient, and whose credentials went on the claim.

Family Workshop was a mental health and behavioral health counseling group with offices in Albuquerque and Rio Rancho, New Mexico. The Justice Department’s settlement announcement describes a mismatch between the people delivering the care and the billing credentials used to obtain Medicare payment.

How the Medicare Claims Allegedly Worked

The government alleged that Family Workshop submitted Medicare claims for clinical social worker services using licensed clinical social workers’ billing credentials while other people actually provided the services. Those workers, the government said, were not authorized to receive Medicare reimbursement. The alleged conduct ran from January 1, 2014, through December 31, 2021.

For an insider, that is a concrete question about the workday. The appointment belongs to a particular patient and worker. The claim tells Medicare whose services it is being asked to pay for. We look at where those accounts separate, and who made the billing decision.

Why the Licensed Name Matters

The Justice Department explained that only licensed clinical social workers may receive Medicare reimbursement for clinical social worker services. The alleged substitution put taxpayers’ money behind credentials that did not match the care billed.

In healthcare billing, a clinic’s enrollment with a payer and its staff’s professional licenses do not tell us who performed a particular service. That connection is in the treatment and billing records, even when the bill goes out in the organization’s name.

This is why we examine the actual worker alongside the professional named on the claim. A staff roster can tell us who was employed. A treatment record can tell us who saw the patient. The billing record can tell us whose identity the payer received. The useful comparison connects them to the same service, instead of stopping at the fact that the clinic employed licensed staff.

What the Settlement Covered

The Justice Department announced the civil settlement on September 9, 2026. It covered the allegedly improper Medicare billing.

Former Family Workshop employees filed the qui tam lawsuit in federal court in New Mexico. The U.S. Attorney’s Office for the District of New Mexico investigated the case.

The Same Question Across Counseling Providers

In the first amended complaint against Connections Community Support Programs, whistleblowers alleged that management instructed workers to select a designated licensed clinician from a billing menu even when that clinician had neither provided nor supervised the care.

In the case involving A Brief Counseling Center, also known as Healthy Counseling Center, the government alleged that services by unlicensed, unqualified or unenrolled therapists were billed as though qualified licensed providers had rendered them.

At Roanoke Comprehensive Treatment Center, the government alleged that Virginia Medicaid counseling claims represented care by credentialed addiction professionals when the personnel lacked those credentials.

What Evidence Is Needed to Prove Fraud?

Proof in a credential-billing case connects the claim to who delivered the care and who chose the credentials on the bill. Our whistleblower experts build those connections with the insider who understands the clinic’s work.

A clinician may recognize work attributed to them. A biller may recognize the instruction to select a different professional. A manager may know who assigned the work and who controlled the billing choices. Our job is to connect that knowledge to the particular health care claims, so the case explains both the inaccurate representation and how it reached the payer.

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 a counseling employee or billing professional who recognizes this pattern, the starting point is the connection between the services delivered and the claims submitted. We work with you to assess that connection and build the case around what you know.

You Know Whose Work Was Billed

If the licensed name on a counseling claim conceals who delivered the care, speak to one of our whistleblower experts about whose work was billed. We build your case with you and bring in Medicare and Medicaid fraud whistleblower lawyers who understand counseling credentials and billing. We stay beside you through the process, turning what you know about the practice into your strongest Medicare whistleblower case.