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Hartford County resident Michael Pines of Avon, a Glastonbury-based psychologist, pleaded guilty to healthcare fraud charges on Wednesday, Jan. 31, the US Attorney's Office for the District of Connecticut announced.
According to federal officials, Pines, who owned and operated Michael B. Pines, Ph.D., P.C., provided psychotherapy to young children, adolescents, and adults and had been individually enrolled as a Behavioral Health Clinician provider in the Connecticut Medicaid Program.
Between January 2017 and October 2023, Pines submitted false claims to Medicaid for psychotherapy services that were not actually provided to clients. Some of these false claims included:
- Claims for days when no services of any kind had been provided to the client, including when he was traveling, vacationing, recovering from surgery, or other times he had not been working;
- Claims for days when appointments had been canceled;
- Claims for days when clients were hospitalized instead;
- Claims for days after he had stopped treating the claimed client;
- Claims for clients that he had never even treated.
Additionally, when Pines would treat more than one Medicaid client in the same family, he would bill Medicaid for the group visit as individual claims instead, which was not permitted, officials said.
In total, Pines defrauded Medicaid of $1,617,679 as the result of his scheme. As part of his guilty plea, he will pay full restitution and will also forfeit several items of jewelry that had been seized during the investigation into him.
Pines faces a maximum prison term of ten years when he is sentenced on Monday, May 6. He is now released on a $250,000 bond until then.
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