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Date: 05-01-2024
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Court: The United States District Court for the Southern District of Illinois
Plaintiff's Attorney: The United States Attorney’s Office for East St. Louis
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Description:
Former VA Psychologist Sentenced to Prison for Submitting False Medical Documents, Health Care Fraud
A district judge sentenced a Herrin woman, formerly employed in southern Illinois as a psychologist with the Department of Veterans Affairs, to 10 months imprisonment after she admitted to submitting false medical documents, obstructing justice and committing Medicare fraud.
Theresa A. Kelly, 57, pleaded guilty in October 2023 to one count of concealing a material fact by trick, scheme or device; three counts of making or using a false writing or document; one count of obstruction of justice and one count of health care fraud. Kelly’s conduct involved a multi-faceted scheme that impacted her employment at the VA, fraudulent billing to Medicare, and the obstruction of a federal civil lawsuit in the Southern District of Illinois.
“As a psychologist for the VA, the defendant was employed to provide important services to veterans, but instead she used her position to submit fraudulent medical documents with the intention of earning otherwise unauthorized leave and reasonable accommodations,” said U.S. Attorney Rachelle Aud Crowe. “Government employees acting to defraud their agencies will be investigated and prosecuted to the fullest extent of the law, and I commend the agencies for their work in bringing this offender to justice.”
Kelly, a licensed clinical psychologist, was employed by the Marion VA Medical Center. According to court documents, between November 2016 and August 2020, Kelly submitted fraudulent medical documentation in the name of real and fake medical providers as part of the approval process for reasonable accommodations and medical leave, including FMLA leave. Kelly admitted to submitting false medical documents with forged signatures of two legitimate medical providers, one of whom is local to the southern Illinois area.
“This sentence sends a clear message that VA employees will be held accountable if involved in fraudulent activities,” said Special Agent in Charge Gregory Billingsley with the Department of Veterans Affairs Office of Inspector General’s Central Field Office. “The VA OIG thanks the U.S. Attorney’s Office and our law enforcement partners for their efforts in this joint investigation.”
In addition to her submission of fraudulent medical documents, Kelly engaged in a scheme to defraud Medicare and obtain payment for psychiatric services that she did not provide to residents of a Southern Illinois nursing home between May 2016 and January 2018. In addition to her full-time job at the VA, Kelly owned a company by the name of TS Onsite Mental Health through which she claimed to provide psychotherapy sessions to patients at Shawnee Christian Nursing Center in Herrin, Illinois. Kelly billed Medicare for more than 400 claims—worth more than $54,000—for services that she did not provide. Kelly billed for at least some of the services on days she was on approved medical leave from the VA. In addition her term of imprisonment, Kelly was ordered to repay $35,795.94 in restitution to the Centers for Medicare & Medicaid Services as repayment for her fraudulent claims.
“HHS-OIG is committed to ensuring that citizens’ tax dollars are protected from fraud and abuse by investigating providers who undermine our federal health care programs and the well-being of patients by submitting fraudulent claims,” said Mario M. Pinto, Special Agent in Charge with the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “We will continue to work with our law enforcement partners to investigate conduct that compromises the integrity of federal health care programs.”
Kelly also admitted to obstructing justice in a civil proceeding in federal court by submitting fraudulent medical documentation to her attorney—the contents of which were used to seek a continuance of the judicial proceeding. In April 2020, Kelly filed a discrimination complaint in U.S. District Court against the Secretary of Veterans Affairs. Rather than proceeding with the case, Kelly submitted a letter impersonating a real physician who had practiced in Anna, IL but had never treated Kelly. Kelly’s lawsuit was ultimately dismissed by the judge.
The investigation was conducted by investigators with the VA-OIG and HHS-OIG. Assistant U.S. Attorney Zoe J. Gross prosecuted the case.
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