St. Louis Psychiatrist Psychotherapy Fraud: Face-to-Face Claims From Out of Town

A St. Louis psychiatrist at Psych Care Consultants agreed to pay $501,556 to resolve psychotherapy fraud allegations that he billed Medicare and Missouri Medicaid for face-to-face care while out of town or for services other practitioners performed. If you worked with the schedules, treatment notes or claims, the gap between who was present and who was billed is the part of this case you may recognize.

The psychiatrist was part-owner of Behavioral Health Services LLC, which owned and operated Psych Care Consultants in St. Louis, Missouri. The U.S. Attorney’s Office for the Eastern District of Missouri announced the civil settlement on July 22, 2025.

Face-to-Face Psychotherapy With the Clinician Away

The government alleged that the psychiatrist falsely represented that he personally provided face-to-face psychotherapy from January 1, 2019, through May 31, 2024. Its account identifies claims made while he was out of town and claims for services other practitioners provided.

We see the absurdity in those claims: the psychiatrist could leave town without missing a face-to-face visit on paper.

Psychotherapy billing also depends on what work the session represents. A Medicare contractor coding article effective January 1, 2025 requires start and stop times or total psychotherapy time, with evaluation-and-management time excluded.

The person who provided treatment may know the session and its duration. Billing staff may see the code and provider identity submitted to the payer. Our work brings those accounts together, so a potential case follows the actual service through to the claim that asked for public money.

The False Claims Act Settlement

The Justice Department described the civil settlement as $250,778 in restitution, doubled under the False Claims Act.

In its March 9, 2026 update about another psychiatrist at the practice, the Justice Department reported that the part-owner had paid his civil settlement.

What the Guilty Plea Adds

In his April 2025 guilty plea, as described in the Justice Department’s criminal-case announcement, the psychiatrist admitted submitting claims to Medicare, Medicaid and private health insurers falsely stating that he had performed in-person services while outside Missouri or outside the country.

In the plea agreement, he admitted submitting a Missouri Medicaid claim for an initial inpatient hospital visit on December 3, 2023, while he was in Hawaii. Face-to-face, from Hawaii.

The same criminal announcement describes his admission that he billed a private insurer for an intravenous ketamine infusion while out of town. Another doctor performed the infusion. The psychiatrist admitted knowing that the other doctor lacked the Drug Enforcement Administration registration authorizing him to administer controlled substances, including ketamine.

The announcement also describes the other doctor’s separate plea agreement. That doctor admitted agreeing to perform services for Psych Care Consultants patients while billing Medicare under the psychiatrist’s name and billing number. The claims were for annual wellness visits, but the other doctor contacted patients by phone rather than seeing them in person.

The announcement describes a wellness visit as a yearly appointment to develop or update a personalized prevention plan, including a cognitive function assessment. In his plea, the other doctor admitted that Medicare paid $3,902 for the fraudulent claims.

A Separate Settlement at the Same Practice

Another psychiatrist employed at Behavioral Health Services LLC reached a separate $360,000 civil settlement, announced in March 2026. The government alleged that she too submitted face-to-face psychotherapy claims to Medicare and Missouri Medicaid while out of town or for services other practitioners performed. Her alleged conduct covered the same period as the part-owner’s civil case.

Her civil settlement included $155,000 in restitution to Medicare and $25,000 to Missouri Medicaid, with those amounts doubled under the False Claims Act. The same announcement reports that she pleaded guilty in December 2025 to making false statements related to health care matters.

When the Treatment Note Tells a Different Story

In Progressions Behavioral Health Services’ settlement, the government described allegations that a former therapist fabricated records for sessions that never occurred and forged a parent’s signature on encounter forms. The government’s complaint against The Journey to Hope, Health and Healing described a former counselor denying that signatures on counseling notes were theirs.

What Evidence Is Needed to Prove Fraud?

For false psychotherapy claims, we assess with you how the bill compares with the actual encounter: who provided the service, when it occurred, where the practitioner was and what the treatment record says. Your account of how the practice worked helps us understand how those claims came to describe different work.

A scheduler may know who was away. A treating practitioner may know whose session went under another person’s name. A billing employee may know how that name reached the submitted claim. Those are different views of the conduct illustrated here, and each can help explain the mismatch.

The St. Louis plea supplies a location that contradicted a billed visit. The parallel cases supply disputed encounters and signatures. Your knowledge of the practice’s ordinary work can give those records meaning. We build on that knowledge with you to pursue a whistleblower case that explains who did the work and who claimed payment for it.

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. We assess how the conduct you know connects to a civil recovery and bring in whistleblower lawyers who understand psychotherapy billing.

You Know Who Saw the Patient

If the clinician on the claim was away, or your own work appeared under someone else’s name, speak to one of our Whistleblower Experts about what happened inside the practice. We build your strongest healthcare whistleblower case with you, bring in health care fraud whistleblower lawyers who know psychotherapy claims, and stay beside you through the pursuit of a recovery.