The Attorney General’s Office has filed civil enforcement actions against two Vermont Medicaid providers for alleged fraud. The lawsuits, currently pending in Vermont Superior Court, Chittenden Unit, Civil Division, were investigated and brought by the Attorney General’s Medicaid Fraud and Residential Abuse Unit (MFRAU). The cases allege separate violations of the Vermont False Claims Act.
In the first case, psychotherapist Robert Martin DuWors, PhD, of Cotuit, Massachusetts, and his business associate Peter Lang of New York City are accused of conspiring to “upcode,” or unlawfully increase Vermont Medicaid reimbursement by billing with inaccurate information. Dr. DuWors is alleged to have allowed Mr. Lang, who is not licensed to practice medicine or psychotherapy, to provide “talk therapy” to Vermont Medicaid patients. Dr. DuWors then billed Mr. Lang’s time to Vermont Medicaid at a licensed clinical psychotherapist’s full rate, resulting in significant overpayments to Dr. DuWors’ practice.
Additionally, MFRAU’s investigation found evidence that Dr. DuWors routinely billed Vermont Medicaid for “impossible time,” whereby he claimed to have personally provided more than 24 hours of Medicaid service on a single date. The defendants are further alleged to have obscured their actions by not maintaining or providing Medicaid treatment records necessary to verify that appropriate services had been rendered.
In a separate case, mental health counselor Lauren Ann LaSante of Rutland, Vermont, is accused of Medicaid fraud after she allegedly refused to provide Vermont Medicaid treatment records to state authorities or her own patients as required by law and professional ethics.
Vermont Medicaid service providers are required not only to bill honestly but also reliably document the services for which they claim reimbursement and promptly make those records available to state investigators. Failure to do so exposes providers to potential liability under state and federal laws. Violation of the False Claims Act can result in a judgment of three times the amount of public funds defrauded plus penalties for every false claim made to the state.
If you suspect someone of abusing the Vermont Medicaid program, please contact Vermont Adult Protective Services at 800-564-1612 and MFRAU at https://ago.vermont.gov/medicaid-fraud-report-form.