October 9, 2013

Double-billing Maine psychologist sentenced to eight months

She defrauded insurance companies of over $69,000 for more than three years.

By Scott Dolan sdolan@pressherald.com
Staff Writer

PORTLAND — A licensed psychologist from South Portland who double billed patients’ insurance companies for counseling sessions that never happened was sentenced on Tuesday to serve eight months in federal prison and pay insurance companies more than $69,000 in restitution.

Judge George Singal ordered Carole Orem-Hough, 55, to surrender and begin serving her prison term on Dec. 23, allowing her to remain free on bail until then while her middle-school-aged son completes his school semester.

Orem-Hough, dressed all in black for the sentencing hearing in U.S. District Court in Portland, told the judge that she was “deeply remorseful and humbled.”

The judge rejected an argument by Orem-Hough’s attorney, Toby Dilworth, that she be allowed to serve a sentence of home confinement rather than prison, but the judge also imposed a sentence less than the year and a day requested by the prosecutor, Assistant U.S. Attorney James Chapman Jr.

Orem-Hough, who provided counseling services from her business Casco Bay Psychotherapy in South Portland, defrauded Aetna, Anthem Blue Cross and Blue Shield, Harvard Pilgrim and OptumHealth Behavioral Solutions for more than $69,000 in false claims for nearly 50 patients, according to court records.

In some cases, she would submit claims indicating that she had provided counseling to patients for two days per week when the patients’ files indicated treatment notes and co-payments for only one day, court records state.

“She knew it was too easy to do, and she knew her chances of getting caught were small,” Chapman said. “Health care fraud is a serious offense. It’s a crisis in this country.”

Dilworth argued that Orem-Hough had already paid the price for her crime: She had lost her license to practice and was preparing to file for bankruptcy.

“Her reputation is shot, and she is completely humiliated,” Dilworth said. “Nobody in their right mind would want to trade places with Carole Orem-Hough.”

Orem-Hough told the judge that she initially became frustrated with insurance companies who wouldn’t pay her for lengthy sessions so she began billing for two shorter sessions, a billing pattern that escalated and worsened.

The case was investigated by the Federal Bureau of Investigation after a patient noticed and reported billing discrepancies in a statement explaining medical benefits from the patient’s health insurance company.

In delivering his sentence, Singal recounted details of when that patient confronted Orem-Hough when the patient discovered the double billing.

The patient accused Orem-Hough of “stealing,” and Orem-Hough responded by saying it was “just insurance,” the judge said.

“I’m troubled by the fact that this is not a one-time occurrence or even a five-time occurrence. We have over 3-1/2 years,” Singal said. “It’s an unfortunate tear in the fabric of society in cases like these that cause people in our country to become so cynical.”

The judge also ordered her to serve three years of supervised release upon completion of her prison term.

Scott Dolan can be reached at 791-6304 or at:

sdolan@pressherald.com

Twitter: @scottddolan

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