May 21, 2013

South Portland psychologist pleads guilty to fraud

By Scott Dolan sdolan@pressherald.com
Staff Writer

PORTLAND — A licensed psychologist from South Portland pleaded guilty Tuesday in U.S. District Court in Portland to committing health care fraud.

Carole Orem-Hough, 55, who provided counseling services from her business Casco Bay Psychotherapy in South Portland from September 2008 to September 2011, waived indictment before Judge George Singal and admitted to double-billing patients’ insurance companies for counseling sessions that never happened, according to court records.

Orem-Hough defrauded Aetna, Anthem Blue Cross and Blue Shield, Harvard Pilgrim and OptumHealth Behavioral Solutions for more than $69,000 in false claims for nearly 50 patients, according to the U.S. Attorney’s Office.

In some cases, she would submit claims indicating that she had provided counseling to patients for two days per week when the patients’ files indicated treatment notes and co-payments for only one day, according to court records.

She is scheduled to be sentenced on Aug. 27. She faces up to 10 years in prison and a fine of up to $250,000.

The case was investigated by the Federal Bureau of Investigation after a patient noticed and reported billing discrepancies in a statement explaining medical benefits from the patient’s health insurance company.

Staff Writer Scott Dolan can be contacted at: 791-6304 or at: sdolan@mainetoday.com

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