Under a proposed plea deal — which has not yet been approved by a judge — Condie would be ordered to serve a three-year prison sentence, pay more than $2.28 million in restitution to Medicaid and also give up what could amount to more than $1.5 million worth of assets to the government.
Condie, 57, is set to be sentenced on Jan. 8 by U.S. District Court Judge Alan Johnson in Cheyenne.
The case relates to millions of dollars of bills that Condie submitted to Medicaid through his business, Big Horn Basin Mental Health Group, on behalf of a network of people who were providing mental health services across the state. Federal prosecutors say Condie made multiple representations in his Medicaid bills, knowing program administrators wouldn’t pay if they were aware of what was actually going on.
A grand jury indictment, filed and publicized by federal prosecutors in May, alleged that every single one of the nearly $6.85 million worth of bills that Condie turned in to Wyoming Medicaid between June 2012 and February 2016 was fraudulent. However, in a Friday court filing, prosecutors say Condie has agreed $2.283 million of his bills were submitted with false pretenses.
Assistant U.S. Attorney Eric Heimann wrote that Condie submitted those particular bills “even though he knew that many of the alleged services were not therapeutically necessary (as defined by Wyoming Medicaid), were not provided through an authorized center (as required by Wyoming Medicaid), were not provided by a properly licensed or supervised individual and/or the substance of the activities did not qualify for billing under the codes used.”
Condie declined to comment on Monday, citing the ongoing court proceedings and advice of his attorney.
In an interview with the Tribune in May — in which he said he planned to put up a “rigorous” defense — Condie indicated that much of the case stemmed from differing interpretations of Medicaid rules. Condie said he’d previously been accused of fraudulent billing in 2011 and that a two-year investigation ended with a finding that there was no evidence of fraud; he said his billing practices hadn’t changed since that time.
“Wyoming Medicaid and the FBI both have 11,000-plus pages of documented evidence that the services were provided and the therapists will, if called upon, will provide testimony [that] not only were services provided, but symptoms were relieved,” Condie told the Tribune in May. “It was good service that was provided.”
Under the plea deal, federal prosecutors have agreed to drop 233 other charges related to the allegations and support a 36-months prison sentence; that’s about 10 months lighter than the 46-57 months a defendant would generally face for the crime under federal sentencing guidelines, Heimann wrote in Friday’s court filing.
Heimann told The Associated Press that, under those guidelines, there would not have been much difference in punishment if Condie had pleaded guilty to additional counts.
“He’s going to prison for three years; he didn’t get away with anything,” Heimann told the AP.
In a May news release announcing the charges, the U.S. Attorney’s Office had suggested that, with a maximum of 10 years per count, Condie faced up to 2,340 years in prison.
Under his Big Horn Basin Mental Health Group, prosecutors say Condie submitted bills on behalf of more than 80 providers who provided services to around 300 patients.
Heimann says the “vast majority” of the providers were not enrolled in Wyoming Medicaid as required by the program’s rules and that Condie “routinely employed individuals who did not have the required training or license to complete clinical assessment of Wyoming Medicaid beneficiaries without proper supervision.”
Condie told the Tribune in May that his providers were not enrolled in Medicaid, but said he did not believe they needed to be under the rules.
After the initial fraud investigation wrapped up in 2013, “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 in May. Condie said then that he would have had no objection to those providers enrolling, had Medicaid officials told him to do that.
In return for submitting the providers’ bills to Medicaid, Condie kept a portion of the money for himself; Condie said in May that other clinicians had approached him about doing their billing and that he agreed to do so for a billing fee and a supervisory fee. Heimann’s filing alleges that, in a couple instances, Condie’s fees amounted to keeping more than half of the money.
When it came to mental health assessments, Heimann says Condie arranged to pay a flat fee to the providers. However, Medicaid pays for those clinical assessments based on the amount of time spent on the diagnosis, and Condie would bill Medicaid for a certain number of “time units,” the prosecutor’s filing says.
“... He did not know how long it had actually taken to complete the assessment and he determined the ‘time units’ to bill based solely on the flat fee he had agreed to pay plus an amount of money he would keep for himself,” Heimann wrote. “The defendant did this with intent to cause Wyoming Medicaid to pay for services for which he knew Wyoming Medicaid would not pay if he truthfully reported that he did not know how long each assessment had taken and truthfully reported that he inflated the bill to pay himself for submitting the claim to Medicaid.”
Heimann also wrote that Condie told some of his providers to include certain mental health disorders in their assessments, even though he hadn’t properly supervised their assessments. Condie also rarely observed therapy sessions or any other information about the services being provided by his affiliates — generally being available by phone — and therefore did not know whether the services were necessary or working, the prosecutor wrote.
Wyoming Medicaid wouldn’t have paid for the services had they known of Condie’s limited role in the assessments, Heimann wrote.
Part of the plea agreement involves Condie forfeiting various properties and cash that’s “traceable to the proceeds of [his] scheme,” Heimann wrote.
That includes giving up: a former guest ranch owned by Big Horn Basin Mental Health Group outside of Shell in the Big Horn Mountains (the Ranger Creek Ranch and various equipment are currently listed for sale for $899,000); a home on Road 5 east of Powell; more than $500,000 held in various bank accounts; and a couple vehicles.
It will be up to Judge Johnson to decide whether to approve the plea deal at the sentencing hearing.