Odyssey Health Group: Impossible Hours, Invented Notes and Audit Obstruction

Odyssey Health Group’s Medicaid fraud case involved more than $1.2 million in claims for rehabilitative behavioral health services that never happened, according to the Justice Department’s account of the criminal court records and trial evidence. The owner submitted claims and then directed employees to create clinical notes to support them. If you worked on those claims or notes, you could see something the finished chart concealed: which came first, the bill or the story about the care.

How Odyssey Health’s Behavioral Claims Worked

Odyssey Health Group operated in Charlotte and enrolled with South Carolina Medicaid to provide outpatient behavioral health services. The Justice Department explained the cross-border arrangement in its trial announcement: South Carolina beneficiaries could use providers within 25 miles of the state border, including Charlotte.

The department described fraudulent claims submitted from 2016 to 2021 to South Carolina Medicaid and its contracted managed care organizations. Money meant for beneficiaries’ mental health care went into a scheme that bought their identities and invented their treatment.

What the Criminal Trial Showed

A federal jury found Odyssey’s owner guilty on May 17, 2024, of healthcare fraud, healthcare-related false statements, money laundering, wire fraud and conspiracy, according to the Justice Department’s trial announcement. The owner was a licensed clinical social worker.

The FBI investigated, and the U.S. Attorney’s Office in Charlotte prosecuted the case.

The Claim, the Clock and the Clinical Note

Beneficiary Identities Became Claims

According to the Justice Department’s trial announcement, the owner used Medicaid beneficiaries’ personal identifying information to submit claims, purchasing that information for some of them. She used some of the fraudulent proceeds to buy more beneficiary names and identifying information. The false claims helped finance the next ones.

The people behind those names contradicted the paperwork. According to the Justice Department’s account of court documents, FBI agents interviewed 21 Medicaid beneficiaries whose names, Medicaid numbers and identifying information had been used for claims. Every one said that neither they nor their children had received mental health services from the owner. Many said the assessments and clinical notes contained untrue information about them. Others said their signatures had been forged.

One-on-One Counseling Filled an Impossible Day

The department’s account of the criminal evidence described billing for more than 11 hours and up to 19 hours of one-on-one counseling in a 24-hour period.

Behavioral health payment can turn on minutes of treatment, a group session or a qualifying program day. Each unit points to different work. Here, the government identified one-on-one counseling, so the useful comparison is the claimed time against the individual sessions actually delivered. A schedule, a clinician’s account and the associated notes speak to that comparison from different directions.

We see the absurdity in selling personal clinical attention by the hour while the people supposedly receiving it say they never received care at all. A very full day. On paper.

Clinical Notes Followed the Claims

According to the Justice Department’s account of the trial evidence, the owner instructed Odyssey employees to create fake clinical service notes after she had filed the fraudulent claims. The instruction and its timing explain what the notes were doing: giving an already-submitted bill the appearance of clinical support.

We would examine those instructions alongside the claim and the beneficiary’s account, because they connect the finished chart to the decision that produced it.

Why the Audit Response Matters

The audit brought another round of fabricated support. The trial evidence, as the Justice Department described it, showed that the owner learned of audits of Odyssey’s Medicaid claims in September 2019, then submitted fictitious patient medical records and made false statements to auditors.

The Justice Department’s later description of the court records shows how far that went:

The records presented for review were themselves part of the scheme. That is why we care about the sequence behind an audit response: what the claim originally said, what support existed, what the auditor asked for and what employees were directed to supply. The finished submission can hide the very decisions an insider remembers.

The attempt to create support also reached a prospective witness. The same release describes trial testimony about a recorded call in which the owner suggested that the witness falsely testify that the owner had provided mental health services to the witness’s children. The story she wanted told matched the care claimed on paper.

The Separate Pandemic-Loan Scheme

The Justice Department’s trial announcement also described a Paycheck Protection Program loan scheme involving Odyssey and Gucci International Inc., a purported event-planning business owned by the Odyssey owner’s boyfriend and co-conspirator. The Odyssey owner submitted false loan applications and supporting documents that misrepresented payroll expenses and employee numbers. She obtained more than $287,000 in COVID-19 relief funds for her companies and Gucci.

False Notes Across Behavioral Health Cases

At Holy Health Care Services, the Justice Department’s account of the owner’s criminal case described claims for visits that did not occur, supported by false community-support visit notes. The owner pleaded guilty. The parallel is the use of clinical records to give nonexistent visits the appearance of documented work.

In its account of the criminal case involving Facing Change, the Justice Department described staff manufacturing records during a MaineCare audit. The case also involved altered diagnoses used to retain eligibility for reimbursement. Its owner was convicted of health care fraud.

These cases bring different decisions into view. A false visit note supplies apparent support for a claim. A manufactured audit response gives the reviewer another false account. For an insider, knowing who directed either one can explain how the paperwork became detached from the care.

What Evidence Is Needed to Prove Fraud?

In the Odyssey case, the evidence connected claims to beneficiaries who denied receiving services, billed counseling hours, instructions to invent notes and false records supplied to auditors. That is the connection we explore with someone who recognizes the same pattern at work.

A billing employee may know when the claim went out. A clinician may know whether the session happened. An employee preparing an audit response may know who requested a replacement account of care. Your view of one decision can help explain records that otherwise look complete. We work with you to connect that knowledge to the provider’s government claims and the people directing them.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Saw When the Notes Were Written

If you were asked to make a chart support care that never happened, tell our whistleblower experts what you saw. We build the case with you around the claims, the actual care and the instructions behind the records, bringing in behavioral health fraud whistleblower lawyers who understand Medicaid billing. We stay beside you as your knowledge becomes a case the government can act on.