LXE Counseling: Face-to-Face Care With an Absent Clinician

The LXE Counseling telemedicine fraud case resulted in a $4,752,102 consent judgment against the company and its owner over alleged false claims to Oklahoma Medicaid, including unapproved telemedicine. The government also alleged that the counseling business changed service dates and codes, billed the same clinician’s time twice, and claimed face-to-face care while its owner was at a funeral, a wedding, or away on trips. For someone who knows the appointments, treatment plans or billing system, those are concrete discrepancies between the care and the claim.

LXE provided behavioral and mental health counseling from offices across Oklahoma, with headquarters in Atoka. Its owner also served as chief executive. The company provided psychotherapy and rehabilitation services through SoonerCare, Oklahoma’s Medicaid program, which the federal and state governments jointly fund and the Oklahoma Health Care Authority administers.

Whistleblowers brought the case, and the United States and Oklahoma joined it. The Justice Department’s July 29, 2016 announcement described six kinds of alleged false claims covered by the judgment. The telehealth fraud allegation was part of that broader behavioral-health billing case. The investigation likewise joined state and federal work. The Oklahoma Medicaid Fraud Control Unit and the Department of Health and Human Services Office of Inspector General jointly investigated the case.

The Medicaid Claims Behind the Judgment

The government’s allegations reached who delivered the care, when it happened, what the claim called it, and whether LXE had approval to provide it remotely. The alleged false billing targeted public money meant for patients who could not afford care.

Unqualified Personnel and Unapproved Telemedicine

The government alleged that LXE billed for services performed by people who were not qualified to provide them. It separately alleged that the company submitted telemedicine claims when LXE and its providers lacked authorization or approval from the Oklahoma Health Care Authority to provide telemedicine services. For LXE, the government’s questions went beyond what the treatment note said: was the person qualified, and had the agency approved the remote care?

The provider’s eligibility also drove a later civil case involving LifeWorks Counseling Associates. There, the United States alleged that the company billed New Hampshire Medicaid for services supplied by a psychotherapist excluded from federal health care programs. Both make the identity and eligibility of the person behind a counseling claim consequential.

A related authorization issue appeared in the government’s case against Acacia Mental Health Clinic. The government alleged Medicaid billing for telemedicine delivered by psychiatrists outside the United States contrary to Medicaid regulations. The common point is that the remote encounter has to be connected to the authority under which the provider billed it.

Changed Codes, Duplicate Time, and an Absent Clinician

The government alleged that LXE changed service dates, times or codes to make claims eligible for reimbursement when they otherwise were not. A separate allegation concerned duplicate face-to-face billing for the same dates and times by the same person, using variations of the owner’s name. Another concerned face-to-face services attributed to the owner while she was attending a funeral, a wedding, or traveling. Billing an appointment could not put the owner there while she was somewhere else.

Time records also featured in the government’s Meditelecare psychotherapy allegations. The Justice Department alleged that telehealth psychotherapy sessions billed to Medicare fell short of the minimum time required for payment and relied on false time records. The parallel is the claimed clinical time: an appointment record and a bill can tell different stories about the same session.

Rehabilitation Without Psychotherapy

The government alleged that LXE billed rehabilitation services for patients who never received psychotherapy, even though its treatment plans represented that psychotherapy was necessary. The Justice Department described Oklahoma’s rule as allowing rehabilitation as a service accompanying psychotherapy.

The treatment plan itself identified care the patient needed. The government alleged that LXE billed for the accompanying rehabilitation while that psychotherapy never happened. The discrepancy ran from the plan through the patient’s treatment history to the rehabilitation claim.

What the Consent Judgment Required

LXE and its owner agreed to the judgment. The court entered it in favor of the United States and Oklahoma. The Justice Department described $4,631,102 of the judgment as triple the amount of false claims and $121,000 as civil penalties. LXE and its owner also agreed with the Department of Health and Human Services Office of Inspector General to national exclusions from Medicare and Medicaid for five years.

What Telehealth Billing Screens Can Miss

Billing screens can flag a suspicious pattern without explaining who changed a claim or why. An insider can supply that connection. In its September 2022 telehealth report, the Department of Health and Human Services Office of Inspector General identified 1,714 Medicare providers whose billing raised concerns warranting further investigation. Its screens included duplicate billing across traditional Medicare and Medicare Advantage, unusually high service levels, and modeled visit hours.

The value for a counseling insider is the connection between the pattern and the practice. Claims data can show overlapping bills. Someone inside the business may know that different versions of a clinician’s name refer to the same person, or why a service code changed before submission. LXE’s allegations put those internal details at the center of the case.

What Evidence Is Needed to Prove Fraud?

For a case like LXE, the useful evidence connects a particular Medicaid claim to the provider, approval, encounter, treatment plan and billing decision behind it. Our work with an insider starts with that connection: what the business knew about the care and what it represented to the payer.

A billing employee may recognize the service code that changed or the same clinician appearing under different versions of a name. A clinical manager may know who actually treated the patient, what qualifications that person held, and whether the psychotherapy in the treatment plan occurred. Someone responsible for provider approval may understand which entity and practitioners the authorization covered. Those perspectives address different allegations in the same case.

The LXE allegations show what an insider may recognize: overlapping face-to-face claims, an owner elsewhere when care was billed, and records changed to make a claim payable. The question for us is how your knowledge connects those discrepancies to the claims and the people directing the billing. Knowing how the practice actually operated can explain why its healthcare billing records tell the wrong story.

Can You Get Paid for Reporting Medicaid Fraud?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. Our work with an insider starts by connecting what the practice knew about the care to what it represented in its Medicaid claims.

You Know the Care Behind the Claim

If you know how a counseling practice’s approvals, clinical work or treatment plans diverged from its Medicaid billing, speak to one of our whistleblower experts. We turn that knowledge into your strongest Medicaid whistleblower case, bring in Medicaid fraud whistleblower lawyers with behavioral-health billing experience, and stay beside you throughout the case.