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November 17, 2020

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Former Employee of Birmingham Area Psychology Clinic Sentenced for Role in Defrauding State Medicaid Agency of at Least $1.5 Million

(MONTGOMERY)–U.S. Attorney Prim Escalona, Alabama Attorney General Steve Marshall and U.S. Department of Health and Human Services -OIG Special Agent in Charge Derrick Jackson, announced the sentencing today of a woman for her role in a scheme to defraud the Alabama Medicaid Agency of at least $1.5 million. Heidi Robertson, 35, was employed as the primary insurance biller at a Birmingham-area psychology clinic that billed the Medicaid Agency for counseling services that were never provided.

Robertson was sentenced to 18 months in prison and ordered to pay $850,000 in restitution by U.S. District Judge R. David Proctor after she pleaded guilty earlier this year to one count of conspiracy to commit healthcare fraud by filing false claims to the Alabama Medicaid Agency for individual and group counseling services for at-risk youth while she was employed at Capstone Medical Resources LLC. The owner of the facility, former Birmingham psychologist Sharon D. Waltz, pleaded guilty in 2019 to defrauding Medicaid of at least $1.5million. Waltz is scheduled to be sentenced by Judge Proctor on December 10.

An investigation was initiated by the Program Integrity Division of the Alabama
Medicaid Agency after an audit showed that billings submitted by Capstone for
counseling services had increased from $99,000 in 2015 to more than $2 million in 2017. The Program Integrity Division referred its findings to the Attorney General’s Medicaid Fraud Control Unit after Waltz submitted falsified records during the Program Integrity Audit.

A subsequent investigation was conducted by the Medicaid Fraud Control Unit and the U.S. Department of Health and Human Services Office of Inspector General. This investigation determined that most claims submitted by Capstone from 2016 to 2018 were fraudulent. Robertson’s role in the scheme included submitting claims using the Medicaid identifications of friends’ and family members’ children for counseling services that never took place. Waltz paid Robertson a 10 percent commission for all claims paid by Medicaid. Robertsonwas employed by Waltz from 2016 through late 2017.

“Robertson’s actions demonstrated reckless disregard for at-risk youth, and she will now face the consequences of those actions,” U.S. Attorney Prim F. Escalona said. “Today’s sentence represents the relentless commitment by the U.S. Attorney’s Office and our law enforcement partners to protect the resources dedicated to the members of our community that are the most vulnerable, our children.”

Attorney General Marshall said, “It is appropriate that this defendant face stern
consequences for engaging in an illegal and immoral scheme to profit at the expense of children in need by claiming payment for services that were never provided. As Attorney General, I stand committed with my federal counterparts to punish those who plunder the public treasury and betray the at-risk youth they were entrusted to serve.”

“Today’s sentencing should serve as a reminder to everyone who transacts business with federal health care programs, including Medicaid, that those programs are protected by a dedicated team of investigators and prosecutors,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “We will not tolerate fraudulent actors who illegally enrich themselves at the expense of patients and the American people.”

The U.S. Department of Health and Human Services OIG, the Alabama Attorney
General’s Medicaid Fraud Control Unit and the Program Integrity Division of the
Alabama Medicaid Agency investigated the case. Assistant U.S. Attorney J.B. Ward and Assistant Attorney General Bruce Lieberman, working as a Special Assistant U.S. Attorney, prosecuted.