Kathleen G. Kane - Pennsylvania Office of Attorney General - Protecting Pennsylvanians

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February 29, 2012

Former Bradford County social worker arrested for allegedly submitting more than $100,000 in false Medical Assistance claims

HARRISBURG ? A former Bradford County social worker was arrested today and charged with using eight different schemes to defraud Medical Assistance and private insurance companies out of more than $100,000.2-29-12 Brinskelle

Attorney General Linda Kelly identified the defendant as Sherri Ann Brinskelle, 38, 318 Rivercliff Drive, Stony Point, North Carolina.  Brinskelle is a licensed social worker who provided individual and family counseling services in Towanda, Bradford County and other neighboring counties when she lived in Pennsylvania.

Evidence and testimony regarding the case was presented to a statewide investigating grand jury, which recommended the criminal charges being filed today.

According to the grand jury, Brinskelle was approved as a Medical Assistance provider in Pennsylvania in 2005 and began submitting claims for reimbursement in 2007 through the Community Care Behavioral Health Organization.

The grand jury found that Brinskelle devised eight different schemes to defraud both Medical Assistance and private insurance companies. From early 2007 through March 2011, Brinskelle allegedly submitted more than $100,000 in false claims to Medical Assistance and private insurance companies through these schemes.

Scheme 1
Kelly said that Brinskelle allegedly submitted claims for periods of time when no services were provided. On many occasions, she allegedly billed for days and weeks that she was on vacation, did not have office hours or was unavailable to meet with clients.

Scheme 2
According to the grand jury, Brinskelle also routinely submitted claims for more weekly sessions than she provided. Brinskelle would allegedly bill Medical Assistance for two or three weekly client sessions when in reality she provided a client with only one session or less per week.

Scheme 3
The grand jury found that Brinskelle also submitted claims for inflated times, allegedly billing for one-hour sessions even though many sessions lasted no more than a half hour.

Scheme 4
Kelly said that Brinskelle also allegedly exploited her Medical Assistance family clients for personal gain by routinely submitting false claims for family sessions.

The charges state that Brinskelle billed for family members who were not actually receiving services; she billed for family members who were not present during a session; and she billed for single family therapy sessions as multiple sessions.

Brinskelle also allegedly misrepresented family therapy sessions as individual therapy sessions on her billings and on several occasions, she allegedly billed twice for the same session by using different codes to describe the services.

Scheme 5 and 6
The grand jury found that Brinskelle submitted back-dated claims for clients, which allowed her to start her billing prior to the start of services.

Kelly said that by intentionally falsifying the date of the client?s first session, Brinskelle was able to obtain payment for dates of service prior to ever meeting with her client.

According to the grand jury, Brinskelle also allegedly submitted claims for client services after their sessions had ended. In these instances Brinskelle allegedly continued to bill Medical Assistance for services that she was no longer providing.

Scheme 7
Kelly said that social workers have a legal duty to bill private insurers first and bill Medical Assistance as the payer of last resort.

The grand jury found that Brinskelle submitted claims to the Medical Assistance program as the payer of the first resort, which resulted in being paid twice for the same sessions of service, once by Medical Assistance and once by private insurers.

Scheme 8
According to the grand jury, Brinskelle submitted claims for services that were not documented in the prescribed manner and were of little or no benefit to the recipient, were below treatment standards or were unneeded.

Brinskelle is charged with 16 counts of Medicaid Fraud, two counts of insurance fraud, one count of theft by deception, and one count of unlawful use of a computer.

The case will be prosecuted in Bradford County by Janice Martino-Gottshall of the Attorney General?s Medicaid Fraud Control Section.

(A person charged with a crime is presumed innocent until proven guilty.)

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