MA: Twin Sisters Charged with Stealing Mental Health Professionals' Information to Defraud Federal, State, Local Agencies

Here’s another case of identity theft for fraud. In this case, the names and license numbers of mental health professionals were misused to defraud Lawrence Public Schools, UMass  Medical School, Medicare, and Medicaid.  From the Massachusetts Attorney General’s Office:

BOSTON – Twin sisters who formerly lived in Burlington have been indicted and arrested in connection with allegations that they billed public agencies for unlicensed psychological services, often using stolen identities to conceal the fraud, Attorney General Martha Coakley announced today.

Nita Guzman, through her company New England Psychological Consultants, Inc., allegedly billed Medicaid, Medicare, and Lawrence Public Schools more than $550,000 for unlicensed mental health services. Her twin sister, Nina Tischer, through her company PsychSupport, Inc., billed a division of UMass Medical School more than $30,000 for unlicensed psychological examinations. Neither sister is a licensed psychologist, a legal requirement for practicing psychology in Massachusetts.

Both sisters, aged 49, were indicted Aug. 7, 2014 by a Statewide Grand Jury. Guzman faces charges of Medicaid False Claims (2 counts); False Claims to Public Agency (1 Count); Larceny (4 Counts); Identity Fraud (2 counts); and Unlicensed Practice of Psychology (2 Counts). Tischer faces charges of False Claims to Public Agency (3 Counts); Larceny (3 Counts); Identity Fraud (3 counts); and Unlicensed Practice of Psychology (3 Counts).

Both sisters lived in Minnesota at the time of the indictments. Guzman was arrested by a Minnesota County Sheriff on Sept. 6, 2014. Tischer turned herself in to Minnesota authorities the next day. Both were held without bail in Minnesota, and will be returned to the Commonwealth and arraigned in Middlesex Superior Court in Woburn on Sept. 16, 2014.

Through their corporations, both located in Lowell, the sisters provided bilingual psychological services to Medicaid and Medicare members in the greater-Lowell and greater-Lawrence areas, performed mental health disability evaluations for the Department of Transitional Assistance and the state’s Medicaid program (MassHealth), and assessed children for learning disabilities for the Lawrence Public Schools.

The investigation of Guzman began when a licensed psychologist reported to the AG’s Office that Guzman’s company had used her name and license number without permission. The psychologist provided her name and licensing information to Guzman in the context of job discussions, but decided not to work for Guzman. Guzman then used that psychologist’s name, license, and other identifying information to bill a Medicaid managed care organization more than $430,000.

Additional investigation by the AG’s Office and federal agents from the Office of the Inspector General for Health and Human Services revealed that Guzman also used the name, license and other identifying information of a second psychologist to bill the managed care organization and the federal Medicare program more than $60,000 of services that the psychologist did not provide.

Guzman also allegedly billed the Lawrence Public School system more than $60,000 for psychological evaluations of students in special education programs. The evaluations were performed by Guzman or Tischer. State regulations require that any such evaluations be performed by a licensed psychologist.

The investigation of Tischer began when a licensed social worker reported the unauthorized use of her name and license by Tischer’s company, PsychSupport. Tischer used the social worker’s name and credentials to bill a division of UMass Medical School for disability examinations on people applying for Medicaid benefits or financial assistance from the Department of Transitional Assistance. Tischer billed UMass more than $8,000 for those evaluations.

Two additional professionals, a licensed mental health counselor and a licensed psychologist, also reported the unauthorized use of their names and licensing information by Tischer. The investigation revealed that Tischer billed UMass more than $30,000 for disability evaluations purportedly performed by the three professionals.

These charges are allegations and the defendants are presumed innocent until proven guilty.

Assistant Attorney General Joshua Orr of the AG’s Medicaid Fraud Division is prosecuting this case. Investigators Eric Panicucci and Ronald Velez, the Department of Health and Human Services Office of the Inspector General, State Police assigned to the AG’s Office, and officials from the Division of Professional Licensure were instrumental in this investigation. The Wright County Sheriff’s Office and Wright County Attorney’s Office also assisted in this case.

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