Powell psychologist charged with 234 counts of health care fraud

Posted 5/25/17

A Wednesday afternoon news release from the office of John Green, the acting U.S. Attorney for the District of Wyoming, summarized the indictment as alleging that Condie: “routinely reported an inappropriate and baseless mental health …

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Powell psychologist charged with 234 counts of health care fraud

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A federal grand jury has indicted a Powell psychologist on 234 felony counts of health care fraud, alleging he submitted more than $6.8 million worth of “fraudulent” bills to Medicaid over a roughly 3 1/2-year period.

Gib Condie made an initial appearance on the charges Tuesday in federal court in Casper and was released on his own recognizance.

A Wednesday afternoon news release from the office of John Green, the acting U.S. Attorney for the District of Wyoming, summarized the indictment as alleging that Condie: “routinely reported an inappropriate and baseless mental health diagnosis”; falsely identified himself as the treating provider when other people — many of them not properly authorized by Medicaid — had provided the services; over-billed Medicaid for clinical assessments; billed for services that Medicaid does not cover; and billed for some services that were not provided.

In an interview, Condie said he plans to plead not guilty at a Tuesday, May 30, arraignment hearing in Cheyenne and then “put up a rigorous and truthful defense.”

The allegations relate to Condie’s business, Big Horn Basin Mental Health Group, Inc. According to the charges, Condie submitted $6,848,808 worth of fraudulent claims between June 2012 and February 2016; Condie said the figure represents everything he billed to Medicaid during that time period, with each count relating to a separate payment from Medicaid.

“The fact is all of those services were provided by people who have the necessary credentials and training. All of the money Medicaid paid was paid for services that were provided,” Condie said. “And I mean, not only the therapists but the clients themselves [or] the clients’ families would testify that that was true — and will, if they’re called upon.”

Condie said he provided good services that relieved symptoms.

“I’m not embarrassed, I’m not ashamed, I’m actually pleased with what we did,” he said, adding that many of the patients were people with developmental delays.

The case was investigated by the Federal Bureau of Investigation, the U.S. Department of Health and Human Services’ Office of Inspector General and the State of Wyoming Medicaid Fraud Control Unit over a period of years.

If Condie is found guilty and convicted of the crimes, he could potentially face years of prison time — and the government says it would seek to take ownership of more than $400,000 in Condie’s bank accounts, two vehicles, farm equipment and various parcels of land that he owns in Powell and the Bighorn National Forest. The indictment alleges that property should be forfeited to the government as “gross proceeds traceable to the commission of the offense.” Condie said some vehicles were seized on Tuesday.

By his account, things began in early 2011, when a colleague accused him of fraud. According to Condie, that two-year investigation concluded with him receiving a letter from Wyoming’s Medicaid Fraud Unit that said there was no evidence of fraud, though that time period is now included in the indictment alleging fraudulent billing.

In November 2015, Condie said Medicaid officials asked for more records; he provided 11,000 pages of documentation, he said. In January 2016, Condie said he was notified that the Medicaid Fraud Unit had found 13 credible allegations of fraud.

The Wyoming Department of Health suspended all payments to Big Horn Basin Mental Health Group in 2016, according to the indictment.

Condie got an attorney, hiring Kline, McCorkle & Pilger of Cheyenne, and he said he heard little from investigators between May and October 2016.

“Then the FBI showed up at my door on a Monday morning,” Condie said. They seized records and computers and interviewed a number of people in Powell.

The investigation culminated on Friday, when a federal grand jury returned the indictment.

The 14-page document, released late Wednesday, accuses Condie of running a “scheme to defraud Medicaid.”

It charges that Condie falsely reported to Medicaid that patients suffered from certain mental health disorders — generally “depression not otherwise specified” or “unspecified mental disorder due to known physiological condition” — when Condie knew they actually hadn’t been diagnosed with that disorder, hadn’t sufficiently examined the patient to make that diagnosis or their treating provider was unauthorized to make the diagnosis.

Further, it says that in some bills, Condie claimed to be the treating provider for services that were actually provided by other people;  some of the people were not authorized by Medicaid to provide the services, the indictment alleges.

Condie says some of the providers were not enrolled in Medicaid, but he believes they didn’t have to be.

”After that ... first investigation, I continued to operate under the belief, that, if people had the right credentials and they had supervision from me, that we could bill Medicaid — and now Medicaid is saying, ‘No, you can’t do that,’” Condie said, adding, “If they had notified me and said, ‘Hey, all these people have to be enrolled as providers, then we would have done that. We wouldn’t have had any objection to doing that, but ... they never told us that they had to be done differently.”

Other parts of the indictment allege that Condie submitted bills that falsely reported the “time units” needed to complete clinical assessments — claiming that assessments took a certain amount of time, when he actually had agreed to pay the treating providers a flat fee and didn’t know how long the assessments had taken.

Another paragraph alleges that Condie provided group therapy, but billed Medicaid for more expensive individual therapy.

Another section alleges that Condie provided skills training, pyscho/social rehabilitation and adult case management that he “well knew” he could not bill Medicaid for, because Big Horn Basin Mental Health Group wasn’t an authorized Community Mental Health Center or Substance Abuse Treatment Center.

Lastly, the indictment says Condie inappropriately billed Medicaid for individual therapy, skills training or psycho/social rehabilitation when in fact he’d provided “habilitative activities” — like swimming, hiking, camping, shopping and playing sports — that did not qualify as “therapeutically necessary rehabilitative therapy” under the state’s Medicaid rules.

Condie said federal authorities are acting on what he believes to be untrue information from Wyoming Medicaid officials.

“Certainly, it’s a little unnerving, it’s distressing, to be told you’re a liar and a thief and a crook, to be told that in writing, also; but it is what it is,” he said.

Condie said the FBI showed up at his house on Tuesday with a warrant for his arrest; at the time, he was working in Montana, so he wound up driving himself to Casper for his initial court hearing before Judge Scott Skavdahl.

He expects a trial will be held within roughly a year.

“They say it’s fraudulent, I say it’s not,” Condie said of his billing. “My attorney agrees and so we’ll meet in court and they’ll bring out the rule books and we’ll go through the rule books and determine that there was no violation of any rules or any laws.”

Condie said he is continuing to practice psychology.

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