LXE Counseling: Face-to-Face Counseling While the Owner Was Away

The LXE Counseling fraud case produced a $4,752,101 civil judgment against the company and its owner for false Oklahoma Medicaid claims. The government’s case included face-to-face counseling billed while the owner was at a funeral, a wedding or on trips. For someone who knew the schedule, the contradiction was concrete: Medicaid was being billed for the owner’s presence while she was somewhere else. The claims charged a taxpayer-funded program for care patients had not received.

LXE was headquartered in Atoka, Oklahoma, with counseling offices across the state. Its owner also served as CEO. The company provided behavioral health psychotherapy and rehabilitation through Oklahoma Medicaid, known as SoonerCare, for people who could not afford medical services. The Oklahoma Health Care Authority administered the program, with funding from both the federal and state governments.

The LXE Counseling Medicaid Judgment

On July 29, 2016, a federal district court entered judgment against LXE and its owner on the governments’ false-claims case. The judgment included $4,631,101 in triple damages for false claims and $121,000 in civil penalties under the federal False Claims Act and the Oklahoma Medicaid False Claims Act.

False Dates and Face-to-Face Counseling

The Justice Department said LXE and its owner altered service dates, times or codes to make otherwise ineligible claims payable. The billing record could make a service appear eligible even when the underlying work did not support that claim.

The double billing involved face-to-face services for the same dates and times by the same person, using variations of the owner’s name. An insider familiar with the names used in the business could recognize the same person behind apparently different billing entries.

The owner’s absence supplied another comparison: claimed face-to-face care against her actual location. The encounter described on the bill depended on her being with the patient.

A separate whistleblower complaint against Victoria Trans-Cultural Center shows how a schedule can expose a similar gap. The whistleblower alleged overlapping patient visits and identified a day’s billed care that had not happened:

Provider Identities and Medicaid Billing

The LXE judgment also covered claims for services delivered by people who were not qualified to provide them. In a counseling practice, the person who treats the patient and the organization that bills for the work can be different. A clinician’s qualifications, the supervision required for the work and the payer’s enrollment requirements each matter to the claim.

For the employee reviewing a bill, the useful connection is between the actual worker, the service that worker delivered and the identity represented to Medicaid.

The whistleblower’s complaint against Texas Behavioral Health described a related billing problem. The whistleblower alleged that some nurse practitioners and physician assistants lacked credentials with Medicare and Medicaid plans and concluded that their claims went under a supervising provider’s name to obtain payment. The complaint also alleged that the physicians did not supply the supervision those claims required.

The same complaint alleged that a chemical dependency intern’s services were billed under a licensed counselor’s identity. The name presented to the payer may conceal who actually did the work.

Telemedicine Without Oklahoma Approval

The LXE judgment included telemedicine claims submitted when neither the company nor its providers had the Oklahoma Health Care Authority’s authorization or approval to provide telemedicine services.

For a person handling telemedicine authorizations, the approval history is part of the billing story. We connect that history to the remote services submitted for payment and to the providers whose work the claims describe. An employee familiar with those approvals could explain a discrepancy that a service date and a counseling code would not reveal.

Rehabilitation Without Psychotherapy

LXE claimed rehabilitation services for patients who had never received psychotherapy. Under the Oklahoma payment rules described in the case, rehabilitation was allowed only as a supplement to psychotherapy. The government also pointed to LXE’s treatment plans, which represented the services as necessary.

Rehabilitation has its own service requirements, including the covered work, staff qualifications, supervision and care plan. In LXE’s case, the payment condition also connected it to another service. The question therefore reached beyond whether a rehabilitation encounter appeared in the chart. It reached whether the patient received the psychotherapy that the rehabilitation was meant to accompany.

For the worker who prepared plans or tracked visits, that distinction provides a way to explain the missing psychotherapy. It also keeps the patient’s treatment in view: the bill represented a relationship between services that the delivered care did not contain.

What Evidence Is Needed to Prove Fraud?

For counseling claims like those in LXE’s case, evidence connects the actual work to the dates, provider identities and services submitted for payment. We examine how schedules, treatment records, provider qualifications and claim lines fit together, including who directed changes to the billing information. A worker who knows why a date changed or whose name was used can explain something the claim alone cannot.

The history of a treatment record can matter too. In its separate complaint against Universal Health Services, the government alleged that a medical director backdated treatment plans and physician orders and signed documents in blank. It also alleged that a patient’s plans copied sections from one reporting period into later periods and included backdated or pre-signed signature pages.

We connect the account of care to how the record was produced and the payment it supported. For the person inside the business, knowledge of that process can be as useful as recognizing a false entry.

What Agency Investigates Healthcare Fraud?

For Medicaid health care fraud, state and federal investigators can work together. The Oklahoma Medicaid Fraud Control Unit and the U.S. Department of Health and Human Services Office of Inspector General jointly investigated LXE Counseling. The case began as a qui tam whistleblower lawsuit, and the United States and Oklahoma joined it. They pursued the false Medicaid claims together.

Alongside the civil judgment, LXE and its owner agreed with the Office of Inspector General to national exclusion from Medicare and Medicaid for five years.

The Whistleblower’s Share of a Recovery

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. In a counseling billing case, the insider’s contribution may be knowing whose work the bill represents, why a service date changed or which promised treatment never reached the patient.

You Know Who Was There

If you worked with LXE’s schedules, claims or treatment plans, or recognize the same practices in another counseling business, talk to our whistleblower experts about what you saw. We build the case with you around the care delivered, the identities billed and the decisions behind the claims, and bring in behavioral health whistleblower lawyers who know Medicaid billing. We stay beside you through the whole journey to build your strongest Medicaid whistleblower case.