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Pittsburgh Woman Arrested for $600K Medical Insurance Fraud

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A counselor from the Pittsburgh area has been arrested on suspicion of fraudulently billing over $600,000 for counseling services which were never provided to patients. The investigation was launched after a tip off was received by the Pennsylvania Office of Attorney General’s Insurance Fraud Division by Highmark Blue Cross Blue Shield.

Highmark claimed that Lisa A. Wally, 33, also known as Lisa A. Smith Wally from McKeesport, PA, had inflated billings for services she provided to her clients, and billed the insurer for services that were never actually provided.

Office of Attorney General investigators discovered Wally had billed for 9,746 office visits for 22 patients between 2011 and 2015. However, investigators only found evidence that 1,987 visits had occurred.

lisa-a-smith-wally

Lisa A. Wally, Twitter.

In total, Wally had received $601,280 in payments for services that were allegedly provided at her offices in Uniontown, Fayette County, but no evidence could be produced to prove that those sessions had ever taken place. Wally was unable to produce any evidence that the sessions occurred as no patient records were kept and no written evidence of the sessions existed. Claims were submitted through her computer.

Investigators interviewed a number of her clients, many of whom claimed that the dates of service on the billing records were incorrect. A number also said that Wally appeared to have claimed for office visits during times when patients were not receiving any counseling or psychotherapy services.

One client who Wally claimed to have provided psychotherapy treatments to from her office said only one session took place, yet Wally’s billing records showed that 402 sessions had been provided. Another client visited Wally on 56 occasions, yet billing records show Highmark had been billed for 906 sessions.

A patient who was referred to in the complaint as C.M., said Wally had used the money she fraudulently obtained to purchase a brand new automobile for herself and another for her mother and father, while Wally also used the money to pay for several expensive handbags. The money had also been used to finance a number of trips, evidence of which could be found on her Facebook page, according to the complaint.

A number of clients had been contacted by their insurance companies who threatened legal action to recover the money from bills that had been sent to them. After confronting Wally, clients said Wally admitted to the fraudulent billing and promised to pay the money back.

The arrest announcement was recently made by Pennsylvania Attorney General Kathleen G. Kane’s office. The case is being prosecuted by Deputy Attorney General Kara Cotter, and a preliminary hearing has been scheduled to take place on December 30, 2015.

Wally has been charged with one count of theft by deception, the unlawful use of a computer, and one count of insurance fraud.

Author: HIPAA Journal

HIPAA Journal provides the most comprehensive coverage of HIPAA news anywhere online, in addition to independent advice about HIPAA compliance and the best practices to adopt to avoid data breaches, HIPAA violations and regulatory fines.

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