Cape Elizabeth Psychologist Sentenced to Eight Months for Health Care Fraud
|U.S. Attorney’s Office October 08, 2013|
PORTLAND, ME—United States Attorney Thomas E. Delahanty, II announced that Dr. Carole Orem-Hough, Ph.D., age 55, of Cape Elizabeth, Maine, was sentenced today by Judge George Z. Singal in the U.S. District Court in Portland to eight months in jail and ordered to pay restitution totaling nearly $70,000 for health care fraud.
According to court records, from September 2008 to September 2011, Orem-Hough was a licensed psychologist doing business as Casco Bay Psychotherapy in South Portland. During that time, she provided counseling services to patients, many of whom were insured by private health insurance plans. Orem-Hough defrauded Aetna, Anthem Blue Cross and Blue Shield, Harvard Pilgrim, and OptumHealth Behavioral Solutions by submitting claims for counseling sessions that never occurred. In many cases, Orem-Hough billed insurance companies for two counseling sessions per week when she only saw the patient once per week.
At the sentencing hearing, Orem-Hough admitted that she submitted false claims to the insurance companies but claimed she felt bullied by the insurance companies and entitled to higher reimbursements.
In imposing sentence, Judge Singal stated that the defendant abused a position of trust because the insurance companies depended on her to submit truthful claims. He also stated that she abused her position of trust with her patients because, by using patient names on false claims, she may have affected their ability to get future reimbursement for services they received if their insurance plans had limits on the amount of mental health benefits.
U.S. Attorney Delahanty stated that “the sentence in this case sends a strong message that health care fraud is a serious offense with substantial consequences for professionals who abuse the system.”
This case was investigated by the Federal Bureau of Investigation after a patient noticed and reported billing discrepancies in an Explanation of Medical Benefit Statement received from the patient’s health insurance company.