Date: 01-10-2018

Case Style:

Case Number: 2:17-cr-00124-ABJ

Judge: Alan B. Johnson

Court: United States District Court for the District of Wyoming (Laramie County)

Plaintiff's Attorney: Eric J Heimann

Defendant's Attorney: Steve Kline and Bill Pilger

Description: Cheyenne, WY - Powell, Wyoming Psychologist Sentenced to Three Years in Prison for Health Care Fraud

Gibson Buckley Condie, 57, of Powell, Wyoming, was sentenced on January 8, 2018, to serve three years in prison for felony health care fraud involving mental health services falsely billed to Wyoming Medicaid, announced United States Attorney Mark A. Klaassen. Condie was also ordered to pay approximately $2.28 million in restitution to the Wyoming Department of Health and the United States Department of Health and Human Services, and forfeit certain assets traceable to the proceeds of his fraud.

Condie, who was a licensed psychologist, had been indicted by a federal grand jury in May 2017 for a scheme to defraud Wyoming Medicaid. Condie pled guilty to one count of health care fraud as part of a plea agreement with the United States government. Condie admitted to operating a scheme involving a number of misrepresentations and false statements intended to cause Medicaid to pay for mental health services for which he knew Medicaid would not pay if he truthfully reported the facts. Specifically, Condie claimed to be the treating provider even though almost all services were provided by unenrolled, and often unlicensed, persons who could not provide mental health services under Wyoming Medicaid.

Condie also routinely endorsed mental health assessments, which claimed that a Medicaid beneficiary had a qualifying mental health disorder, when in fact Condie had neither performed nor properly supervised the assessments. These assessments were often done by individuals who did not have the required training or license to diagnose mental health disorders. Condie then submitted false bills for these assessments, and submitted bills for other treatment services based on these improper assessments.

Finally, Condie billed for life skills training, psycho/social rehabilitation, and adult case management services even though the beneficiaries had not been properly diagnosed with a mental health disorder, the activities billed for did not qualify as medically necessary therapy, and he did not operate a qualified community mental health center. As a result of Condie’s false statements and misrepresentations, Wyoming Medicaid paid Condie $2,283,792.49 for mental health services that did not qualify for

Medicaid reimbursement. Condie in turn distributed a portion of this money to the unenrolled, and often untrained and unlicensed, individuals who actually spent time with the beneficiaries.

"Health care fraud is a serious crime that harms all of us. This criminal activity diverts limited health care resources, driving up costs that affect federal and state budgets and raises premiums. The prison term and monetary penalties imposed on Gibson Condie today show that individuals who engage in such crimes will be brought to justice," said U.S. Attorney Mark Klaassen. "We will continue to aggressively prosecute any health care provider who engages in this type of criminal activity."

"Today's sentencing of Gibson Condie should send a strong message to anyone considering engaging in health care fraud," said FBI Denver Special Agent in Charge Calvin Shivers. "The FBI will continue to work with our law enforcement partners to protect our government's health care system and our economy from those engaged in these types of fraudulent schemes."

Steve Hanson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations-Kansas City Region, stated, "Our office will continue to pursue individuals who file fraudulent claims for reimbursement with HHS funded programs to ensure those individuals are held accountable for their actions."

"Serving as a Medicaid provider is a privilege, which carries the responsibility to account for taxpayer money with honesty and transparency," said Travis J. Kirchhefer, Senior Assistant Attorney General and Director of the Wyoming Office of Attorney General’s Medicaid Fraud Control Unit. He continued, "The Wyoming Attorney General's office, through the Medicaid Fraud Control Unit and the Division of Criminal Investigation, looks forward to continued cooperation with our federal partners to ensure that medical providers do not abuse the public trust."

United States District Court Judge Alan Johnson imposed the sentence. This case was investigated by the Federal Bureau of Investigation, the U.S. Department of Health and Human Services’ Office of Inspector General, and the Wyoming Medicaid Fraud Control Unit. The case was prosecuted by Assistant U.S. Attorneys Eric Heimann and Nicole Romine of the U.S. Attorney’s Office for the District of Wyoming and Special Assistant United States Attorney Travis Kirchhefer of the Wyoming Medicaid Fraud Control Unit.

Suspected fraud against Medicaid or Medicare can be reported to the U.S. Department of Health and Human Services’ Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477) and the agency’s website https://oig.hhs.gov/fraud/report-fraud/. Wyoming residents can call the Wyoming Medicaid Fraud Control Unit toll free at 1-800-378-0345, or visit their website at http://ag.wyo.gov/medicaid-fraud-control-unit.

Outcome: Defendant was sentenced to three years in prison.

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