This is my experience, opinion and part of a complaint I filed with the Ct. Department of Public Health regarding my experience with a therapist in CT.. The case is closed, and it is now public information. The Ct. DPH’s consultant LCSW somehow found that no violation of State Statutes occured. However there was a small success in that the therapist was asked to complete CEU’s in “office and biiling practices” and “client/therapist boundaries”. He was also forced to pay back the money he “overbilled” the insurance company for and to drop himself as a provider. I’ve been told that these are “relative victories” in dealing with a licensing agencies, as they normally dismiss 80% of all complaints up front, and only actually discipline 2% of all therapists that are complained about.
Leonards(timeline) Billing History and “insurance fraud” and “post therapeutic relationship”
2004: Leonard Billed appropriately for 5 sessions that took place in 2004.
2005: Leonard billed appropriately from January of 2005 until September 3, 2005. After this time there are no claims filed through the December 30, 2005. There is no paperwork within the petition file to show claims made, denied or paid for this time period.
In March 2006 Leonard told me that I owe him money from 12 sessions in the fall of 2005 he did not get paid for by A****Insurance. He said, “you owe me some money, your insurance company did not pay me for sessions during that time period. At the time I believed him, and made a payment schedule and paid it off by July 15th of 2006.I asked for but never received an actual bill, nor did I receive receipts In October of 2006 while on the phone with A**** Insurance, regarding separate matter unrelated to this case, I asked the representative why I owed Leonard this money and if and why they denied the claims. I was told by the representative that Leonard did not file paperwork at all for that time period and that by contract I was held harmless and owed him nothing. It was too late and I had already paid Leonard the money he claimed I owed him. I did confront him at our next session but he claimed at the time that he had filed paperwork and that he would check into it. Time went by and I neglected to ask him about it. It was only a few months later that he triple billed for various dates in January 2007 and February 3rd, 2007.
2006: Leonard billed weekly and appropriately from January 7, 2006 to June 3, 2006. Then in “similar fashion” to 2005, he did not submit claims from after June 3, 2006 through December 29, 2006 ….until December 30, 2006.
On December 30, 2006Leonard submitted claims for sessions dating back until June 17, 2006 to December 30, 2006…a total of 23 sessions. Looking at the payments made in the petition file it appears that some of Leonard’s claims were rejected at this time. I do not know exactly why, but I believe it would be either because of A***Insurance “timely filing” requirements, or Leonard may have needed to obtain authorization for “additional sessions” (beyond an automatic 20 per year) and did not attempt to do so.
A client is “held harmless” in both of these situations.
2007: In January 2007 Leonard billed for sessions twice weekly,Tuesdays and Saturdays, for the entire month of January and February 3, 2007, on February 3, 2007.
I saw him 3 times in January of 2007 and ( 1/7, 1/21, 1/28) and on 2/4 as shown on my calendar (I did not see him on February 3, 2007)
I discovered this on 3/3/07 by checking my billing on line on A****Insurance website.
I confronted Leonard regarding this “insurance fraud” and made a deal with him that he was not to bill A***Insurance for my next 7 sessions in order to make up for those he already “got paid for” I was willing to let it go with this arrangement. On May 8, 2007 I received a letter from A***Insurance authorizing an additional 6 sessions. I immediately realized this meant he violated our verbal agreement and billed anyway. I again checked my claims on A**** Insurance website and saw that Leonard had billed once weekly (if we had a session) from 2/4/07 until 4/29/07.
I immediately confronted him in an email. This was then followed by a phone call from him at 1120 pm. Leonard took an aggressive stance, yelling at me over the phone that my “ expectations were too high” and that I had a “holier than thou attitude”. He also said in a very nasty tone “what would you like me to do about it?!” He also claimed during this phone call that he “was just trying to see how fast A*** Insurance would “turn over benefits” which made absolutely no sense to me. I felt sick after this phone call and my “BS meter was spinning” I followed up with another email the next day.
After a couple emails and a couple phone calls Leonard agreed to meet me at my house to fully discuss the issue on 5/12/07. While here he cried his “crocodile tears” trying to gain my sympathy. He claimed his “son was suicidal” and that he and his wife had made some “poor investment choices”, that they were close to bankruptcy, and might have to sell their house. He managed to gain my empathy, but certainly not my trust. Leonard wanted the opportunity to earn my trust again so I agreed to meet with him on a weekly basis, not as a therapist, but only as a human being who wanted to prove he was trustworthy. I was feeling extremely conflicting emotions, and it is then I said to him “you can no longer be my therapist, but you’re not my friend either, I do not know what to call it”. This was a phrase I said to him at least 3 times in separate discussions in the next few months.
Please see the attached schedule for info regarding the times we met, as well as my calendar included in this letter. (There are major inconsistencies with his scheduling of clients in his “billing grid” at times when I saw him other clients are listed)
I also made it very clear to Leonard that I wanted him to pay back A*** Insurance for the sessions he “stole”, and did not particularly care how he did this.
I also asked for the money he had taken from me back in 2006. He said he would write a check to a charity in my name, but did not offer to write a check directly to me.
I continued to meet with Leonard for several months in a relationship I still do not have a name for other than “former therapist and former client”. These meetings were highly unproductive, we would take a walk, and talk, it was mostly what Leonard calls in his notes, “chit-chat”, although Leonard still tried at times to play the “therapist role”.
The trust was never rebuilt. I would ask him at times if he thought of how to pay back the insurance company and he either would not respond, change the subject or say that he couldn’t do that as it would “open up a whole can of worms” and he would not do that.
Over time, these sessions became further between and nothing was being accomplished. I strongly believe that Leonard had no intent to pay the insurance company back and that the only reason he was meeting with me was to ensure that I was not going to turn him in.
Obviously “this game” could not go on forever.
The New Year was coming around and I was quite tired of carrying this “burden”. On December 31,2007 I anonymously reported an “insurance fraud” claim to A*** Insurance’s SIU unit.
Leonard was contacted by A**** Insurance and by early February.
At the end of my morning session on 2/2/08 Leonard told me he was being audited by A**** Insurance. (but he did not know I was the one who turned him in as the complaint I made was originally anonymous.). He said this was his “worst nightmare”, and asked me to consider changing the dates that I saw him. I emailed Leonard later in the week and said “no” and that I would not lie for him.
On 2/9/08, at the end of my session Leonardtold me he had spoken to an attorney regarding the audit and that the attorney told him “someone probably turned him in” and asked me if I was the one who did. Feeling absolutely terrified I said “yes”. I do not recall the conversation immediately following. I could not stay at his office to further discuss it as I had an event to attend that I needed to arrive at by at 1130 am in town. I do not recall how we got in contact later in the day, email or phone, but Leonard wanted to further discuss the situation.
In retrospect, I never would do this again! I went back to his home office for 430 pm and we talked until 930 pm. I was fearful enough going there that I asked a couple of friends to call and check to make sure I was ok.
Leonard asked me to bring along my calendars for the previous two years so that I could give him the dates I actually saw him. This is the very first thing that occurred after I arrived at 430 pm.
During the course of this meeting Leonard said the following:
Leonard said “I could go to jail for this” (speaking about himself)
Leonard made a big deal and said “I forgive you for what you’ve done”
Leonard said to me “you went outside the relationship”
Leonard said “My son was suicidal before this might put him over the edge”
Leonard said “I will never be with a man as long as I deal with issues this way.”
Leonard said “He will feel very sorry for me when I realize what I’ve done”. (by turning him in)
Leonard called me self righteous and said I had a” holier than thou” attitude.
As I was leaving his office Leonard last words he said astonishingly were “too bad I can’t get paid for this”
It was an extremely emotionally draining experience to say the least. I felt “beat up” and had a bad headache afterward.
I only saw Leonard one time after that and that was so I could put closure on the relationship. On or about August 14, 2008 I met with Leonard and (finally) officially “fired” him as my therapist. Through his self disclosure and my experience with Leonard, he does not appear to like to put closure on relationships and likes to leave things “open ended”. While this is good in theory, I find a final closing (at least of “a phase” of any relationship) necessary to move forward.
During the investigation of my original petition it was found that there was “no pattern indicating Leoanrd intentionally committed fraud” and that fraud could not be proven. While it could not be proven that Leonard “wrongfully billed” more than myself and my ex husband…there was a pattern in his billing on my account as can be seen from the previous writing here.
It appears to me that in January 2007, upon rejection of his claims from 2006 for timely filing ( for my sessions) or other reasons, perhaps Leonard sat down and “intentionally” tried to recover monies he essentially ( for lack of better terms)“screwed himself out of”, through his “lack of billing”…. I would call this Insurance Fraud”.
This is not “sloppy record keeping or sloppy billing” it is just not billing, then willingly and intentionally filling out paperwork for the sessions in January 2007 that did not occur “to recover the funds”. “Being Busy” and not having time does not seem to be an issue to me either as in reviewing Leonard’s (highly inaccurate) “psychotherapy notes” of me in the petition file, he apparently had time to write 6 to 12 page “rants” allegedly about me (these notes showed clearly the counter-transferrence he was experiencing)….and the content of the notes is certainly questionable as to it’s factual nature. ( really many enteries are falsified) I do not believe these notes were all written right after sessions, but no matter when they were written, I think Leonard’s time would have been better spent working on his billing.
There was an apparent pattern here as Leonard had a pattern of “not billing” and then later trying to recover money from me.Then, when he knew that wouldn’t work again, he tried to recover the money from A**** Insurance, but I discovered that as well. While he did not steal money from me in 2007 as he did in 2006, he stole sessions, which have a monetary value for me. These can be limited in number by A*** insurance as they have to approve sessions beyond an automatic 20 per year. For additional sessions it is my understanding that proper documentation must be provided and/or authorization given. Perhaps Leonard did not want to do the work to file this information. From what I see paperwork does not exist in the petition file to show that he at least attempted to get additional coverage.
In conclusion, Leonard lied to me in 2006 regarding not getting paid by A****Insurance for sessions in the Fall of 2005, and lied to A**** Insurance in January of 2007 by triple billing for sessions that month. Did he do this to recover the money from claims “rejected” in 2006? It would appear so to me. Had he not lied to me previously in 2006, I would not have had reason to track his billing to A**** for my sessions, but I had reason to believe that Leonard might “do it again”.
Filed under: Buyer Beware, Insurance Fraud, Licensing Board Complaints, Mental Health, Red Flags of bad therapy, Therapy | Tagged: caveat emptor, insurance fraud, LCSW, mental health, psychology, psychotherapy, ruder, therapist, therapy, trust, westport |