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Attorney General Ellison obtains guilty plea for over $1 million in Medicaid fraud

Jonathan Newcomb and one other plead guilty; defrauding Medicaid program over $1 million by overbilling therapy services, aiding and abetting interpreters and transportation providers committing fraud, and billing for illegitimate services

 

September 27, 2021



September 23, 2021 (SAINT PAUL) — Minnesota Attorney General Keith Ellison today announced that his office obtained a plea of guilty against a licensed marriage and family therapist who led a network that defrauded Minnesota’s Medical Assistance (“Medicaid”) program out of over $1 million.

“It’s shameful when any service provider defrauds the Medicaid program. They break the public’s trust and put profits before the patients who count on them for honest, quality care and services,” said Attorney General Ellison. “My office will aggressively pursue and prosecute bad actors from cheating vulnerable Minnesota families out of necessary resources they depend on to afford their lives.”

In May 2020, the Medicaid Fraud Control Unit (“MFCU”) in Attorney General Ellison’s office charged Jonathan Howard Newcomb and 15 others for their conduct in an expansive enterprise that stole from the Medicaid program in a scheme lasting nearly 5 years. Newcomb provided therapy services to clients at his Anoka clinic, Newcomb Counseling. Through Newcomb’s clinic, the enterprise swindled the Medicaid program by:

• Billing for group therapy services as if the services were provided in individual sessions;

• Billing for therapy services that did not occur;

• Certifying interpreter and transportation services that were provided in group sessions as if they were provided in individual sessions;

• Certifying interpreter and transportation services that were not provided at all.

Medicaid pays a higher rate, on a per recipient basis, for therapy, interpreter, and transportation services provided in individual sessions rather than in group sessions. Medicaid will not pay for services that are not provided.

From January 1, 2014 through June 30, 2018, the Medicaid program overpaid $136,918.92 for therapy services, $260,828.16 for interpreter services, and $357,315.44 for transportation services at Newcomb’s Anoka clinic.

In his plea, Newcomb acknowledged swindling the Medicaid program as part of a separate network, independent from his Anoka clinic. Working primarily with two other individuals, this network operated a clinic located in Minneapolis that went by multiple names and also claimed to provide therapy services to Medicaid recipients. The clinic, however, did not ever receive approval to provide any therapy services to Medicaid recipients or bill the Medicaid program. Newcomb was also not permitted to supervise therapy services at the clinic. The network defrauded the Medicaid program by:

• Billing for services under Newcomb’s unique provider number, as if the services were provided at Newcomb’s Anoka clinic, when the services were actually provided by unlicensed, unsupervised “therapists” in Minneapolis;

• Billing for therapy services that did not happen;

• Billing for “services” that were not therapy services;

• Certifying interpreter services that did not happen.

Between January 1, 2017 and December 31, 2018, the Medicaid program overpaid $433,374.37 for therapy services and $68,576.00 for interpreter services at this clinic.

A sentencing date for Newcomb has not yet been set. Thus far, one other co-conspirator has pled guilty, while cases for 14 others remain pending in Anoka county district court.

This case was investigated and prosecuted by the Medicaid Fraud Control Unit (MFCU) in the Office of Minnesota Attorney General Keith Ellison. The Minnesota MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $3,651,076 for Federal fiscal year (FY) 2021. The remaining 25 percent, totaling $1,217024 for Federal fiscal year (FY) 2021, is funded by the State of Minnesota.

 

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