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Date: 05-10-2024
Case Style:
Case Number: 3:24-cr-00014
Judge: Sarala V. Nagala
Court: The United States District Court for the District of Connecticut (New Haven County)
Plaintiff's Attorney: The United States Attorney’s Office in New Haven
Defendant's Attorney: Richard R. Brown
Description:
Glastonbury Psychologist Sentenced to Prison for Defrauding Medicaid of More Than $1.6 Million
MICHAEL B. PINES, 75, of Avon, was sentenced to 27 months of imprisonment, followed by 3 years of supervised release, for defrauding Medicaid of more than $1.6 million.
Pines is a psychologist who owned and operated Michael B. Pines, Ph.D., P.C., located in Glastonbury. Pines provided psychotherapy to young children, adolescents, and adults, and he was enrolled individually as a Behavioral Health Clinician provider in the Connecticut Medicaid Program (“Medicaid”).
Between January 2017 and October 2023, Pines submitted and caused to be submitted fraudulent claims to Medicaid for psychotherapy services that were purportedly provided to his Medicaid clients. Specifically, Pines submitted claims for dates of service when no services of any kind had been provided to the Medicaid clients identified in the claims, including when he was traveling, on vacation, recovering from surgery, or otherwise not working. He also submitted claims when an appointment had been canceled, when the claimed client was in the hospital, when he had stopped treating the claimed client, and when the claimed client had never been his client. In addition, when Pines treated multiple Medicaid clients in the same family at the same time, he billed Medicaid for the group visit as multiple individual claims, a practice that he knew was not permitted by Medicaid.
The investigation revealed that Pines used his business bank account for numerous personal expenditures.
Through this scheme, Pines defrauded Medicaid of $1,617,679. Judge Nagala ordered Pines to make full restitution. Pines also forfeited 16 pieces of jewelry, which he paid for using his business bank account, with an appraised replacement value of $67,685.
On January 31, 2024, Pines pleaded guilty to health care fraud.
Pines who is released on a $250,000 bond, is required to report to prison on June 24.
This investigation was conducted by the U.S. Department of Health and Human Services, Office of the Inspector General (HHS-OIG) and the Federal Bureau of Investigation. The case was prosecuted by Assistant U.S. Attorney David T. Huang.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS.
Outcome:
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Defendant's Experts:
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