Beaumont counselor pleads guilty to Medicaid fraud

Beaumont counselor pleads guilty to Medicaid fraud

 A 59-year-old Beaumont mental health care counselor pleaded guilty to health care fraud in the Eastern District of Texas.

Douglas Duane Franklin pleaded guilty to health care fraud Nov. 15 before U.S. Magistrate Judge Zack Hawthorn.

According to information presented in court, since 2007, Franklin has been the owner and sole provider at Guiding Light Counseling Service, PLLC, where he provides mental health counseling services, for which he bills Medicaid, Medicare and private insurance.  Between 2007 and 2019, Franklin was reimbursed $591,600.69 for three different time-based counseling CPT codes, all in durations of 30 minutes or more. Medicaid rules require that the indicated time is spent face-to-face with the patient, and expressly does not include time for documentation or other administrative activities. Between 2007 and 2019, Franklin submitted over 10,000 claims for visits exceeding 30 minutes or more.

During the course of a months-long investigation, investigators with the U.S. Attorney’s Office, the Federal Bureau of Investigation, Health and Human Services - Office of the Inspector General and the Texas Attorney General’s Medicaid Fraud Control Unit discovered that Franklin had patient sessions scheduled in 30-minute increments, some of which were double-booked. However, out of the 10,215 claims submitted by Franklin, only one was for a 30-minute visit. All of the remaining visits were billed under the 45-minute or 60-minute CPT codes, which provided for an increased reimbursement rate.  Franklin was paid a total of $591,600.69 for all claims under the CPT codes when he was only entitled to receive $321,772.50. As a result of Franklin submitting fraudulent claims, he was overpaid  $269,828.19 by Medicaid.   

Under federal statutes, Franklin faces up to 10 years in federal prison at sentencing.

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