Glastonbury Psychologist Sentenced to Prison for Defrauding Medicaid of More Than $1.6 Million
Department of Justice, U.S. Attorney's Office, Connecticut. Published May 10, 2024.
Pines submitted fraudulent claims to Medicaid for psychotherapy services not provided, including on dates he was not working or appointments were canceled, and billed group family visits as multiple individual claims.
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1MICHAEL PINESGlastonbury, CT$0Vanessa Roberts Avery, United States Attorney for the District of Connecticut, announced that MICHAEL B. PINES, 75, of Avon, was sentenced today by U.S. District Judge Sarala V. Nagala in Hartford to 27 months of imprisonment, followed by 3 years of supervised release, for defrauding Medicaid of more than $1.6 million.
According to court documents and statements made in court, Pines is a psychologist who owned and operated Michael B. Pines, Ph.D., P.C., located in Glastonbury. Pines provided psychotherapy to young children, adolescents, and adults, and he was enrolled individually as a Behavioral Health Clinician provider in the Connecticut Medicaid Program (“Medicaid”).
Between January 2017 and October 2023, Pines submitted and caused to be submitted fraudulent claims to Medicaid for psychotherapy services that were purportedly provided to his Medicaid clients. Specifically, Pines submitted claims for dates of service when no services of any kind had been provided to the Medicaid clients identified in the claims, including when he was traveling, on vacation, recovering from surgery, or otherwise not working. He also submitted claims when an appointment had been canceled, when the claimed client was in the hospital, when he had stopped treating the claimed client, and when the claimed client had never been his client. In addition, when Pines treated multiple Medicaid clients in the same family at the same time, he billed Medicaid for the group visit as multiple individual claims, a practice that he knew was not permitted by Medicaid.
The investigation revealed that Pines used his business bank account for numerous personal expenditures.
Through this scheme, Pines defrauded Medicaid of $1,617,679. Judge Nagala ordered Pines to make full restitution. Pines also forfeited 16 pieces of jewelry, which he paid for using his business bank account, with an appraised replacement value of $67,685.
On January 31, 2024, Pines pleaded guilty to health care fraud.
Pines who is released on a $250,000 bond, is required to report to prison on June 24.
This investigation was conducted by the U.S. Department of Health and Human Services, Office of the Inspector General (HHS-OIG) and the Federal Bureau of Investigation. The case was prosecuted by Assistant U.S. Attorney David T. Huang.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS.