Former Birmingham psychologist gets federal prison and $ 1.5 million restitution in Medicaid fraud case

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A former Birmingham psychologist has been convicted after defrauding Alabama’s Medicaid agency of at least $ 1.5 million by filing false claims for counseling services that were not provided.

Sharon D. Waltz, 51, pleaded guilty and was sentenced Thursday to three years in federal prison. She was also ordered to pay $ 1.5 million in restitution, according to a joint statement by U.S. District Attorney for the Northern District of Alabama Prim Escalona, ​​Alabama Attorney General Steve Marshall and the Department of Justice. Health and Human Services – Office of Inspector General, Special Agent Derrick L. Jackson.

Waltz operated Capstone Medical Resources in several locations across the state, with its main manager in Birmingham. Among other services, Waltz offered individual and group counseling sessions to at-risk youth. The charge against her indicates that many services billed to the Alabama Medicaid agency were never performed.

She is the former mistress of Jonathan Dunning, the former CEO of Birmingham Health Care who was sentenced to 18 years in federal prison for siphoning off $ 13.5 million destined for healthcare for the poor. Waltz, who worked with Dunning at BHC clinics, was not charged in the case but testified against Dunning in the 2016 trial. Waltz has two children from Dunning, who was his married boss at the time. She filed a sexual harassment complaint in 2013, but the case was dismissed in 2015.

Birmingham Health Care was part of a nationwide network of federally funded clinics to treat the poor. It is now called Alabama Regional Medical Center (ARMS). Dunning’s release date from a Louisiana prison is August 9, 2032.

Jonathan dunning

In the case against Waltz, the program integrity division of the Alabama Medicaid agency opened an investigation after an audit showed that Waltz’s bills to the Medicaid agency had risen from 99,000. $ in 2015 to over $ 2.2 million in 2017. The conclusions of this audit have been transformed. to the Attorney General’s Medicaid Fraud Control Unit after Waltz submitted forged documents during the audit.

A subsequent investigation was conducted by the Medicaid Fraud Control Unit and the Bureau of Investigations of the US Department of Health and the Office of the Inspector General of Human Services. This investigation determined that the majority of claims submitted by Capstone from 2016 to 2018 were fraudulent and that Waltz submitted and ordered its employees to submit claims for consulting services that never occurred, and in some cases for individuals, including family members and friends of employees. who never received any services at all.

In July 2020, a second woman pleaded guilty to conspiracy to commit healthcare fraud involving a former Birmingham-area psychology clinic that defrauded the Alabama Medicaid agency of at least $ 1.5 million.

Heidi Elizabeth Robertson, 35, entered her plea in the case which involved counseling services that were never provided. Authorities say Robertson was the main biller for Capstone Medical Resources LLC, which filed bogus claims for individual and group counseling services for at-risk youth. She was sentenced to 18 months in November and ordered to share restitution with Waltz.

The OIG of the US Department of Health and Human Services, the Alabama Attorney General’s Medicaid Fraud Control Unit, and the Alabama Medicaid Agency’s Program Integrity Division have investigated the case. Assistant U.S. Attorney JB Ward and Assistant Attorney General Bruce Lieberman, working as Special Assistant to the U.S. Attorney, have been prosecuted.

“Waltz’s actions demonstrated a reckless disregard for at-risk youth, and she will now have to face the consequences of those actions,” Escalona said. “Today’s sentence represents the tireless commitment of the US Attorney’s Office and our law enforcement partners to protect the resources dedicated to those members of our community who are most vulnerable, our children.

Marshall said: “It is important that Sharon Waltz is fully held to account for engaging in her illegal and immoral scheme to rob hard-working taxpayers and take advantage of children at risk. As Attorney General, I commit with our friends in federal law enforcement to find and punish anyone who loots the public treasury and harms those they have been assigned to serve. “

“Today’s conviction should serve as a reminder to all who deal with business with federal health care programs, including Medicaid, that these programs are protected by a dedicated team of investigators and prosecutors,” he said. Jackson said. “We will not tolerate fraudulent actors who illegally enrich themselves at the expense of patients and the American people.”

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