Beginning in 2018, Gabriel Adam Alexander Luthor, a.k.a. Gabriel Adam Alexander Langford, 39, and Elizabeth Christine Brown, 42, intentionally devised and carried out a scheme to overbill Medicare, Medicaid, and other insurers for medical services provided through Golden Victory Medical, LLC (GVM). Luthor and Brown were in a relationship, and together founded GVM in 2018.
According to court documents, one of the main medical services GVM claimed to provide was neurofeedback therapy. During neurofeedback therapy, a medical provider places sensors on a patient’s scalp to obtain images of the patient’s brain waves, for the purpose of indicating the effects of interventions meant to treat mental-health conditions. But according to the indictment, Luthor and Brown fraudulently overbilled insurers for GVM’s neurofeedback services using numerous inapplicable medical codes.
For example, GVM repeatedly submitted claims to insurers using medical codes that did not cover the neurofeedback services that GVM provided, combinations of codes that by definition could not be combined, and codes that indicated that GVM’s patients received a longer duration of services than the company had actually provided. Luthor and Brown caused GVM to continue submitting false claims even after repeated warnings from insurers, an outside auditor, and the Center for Medicare and Medicaid Services.
In total, GVM submitted hundreds of thousands of false claims to insurers, many of which the insurers paid, resulting in an estimated loss of over $15 million. Millions of dollars in fraudulent proceeds were transferred from bank account to bank account and ultimately retained by Luthor and Brown. Luthor and Brown used the funds to purchase a mansion in Eden Prairie and to pay their living expenses and the living expenses of other girlfriends of Luthor’s, who lived with Luthor and Brown and assisted in the fraud scheme.
In another case, a psychologist has been sentenced to 24 months in prison followed by three years of supervised release for fraudulently billing for counseling services never actually rendered, announced U.S. Attorney Andrew M. Luger. According to court documents, Charles Howard Jorenby, 57, was a licensed psychologist and owner of Life Dynamics, Inc., a counseling center located in Prior Lake. From at least January 2013 through February 2020, Jorenby orchestrated a scheme to defraud the Shakopee Mdewakanton Sioux Community (SMSC), which is responsible for funding its own tribal members’ health care costs. In order to administer its own self-funded costs, SMSC contracted with Blue Cross Blue Shield Minnesota (BCBS) as its health care administrator and processor for provider billing. Jorenby realized that, within the relationship between SMSC and BCBS, billed services were fully covered, and no individuals received any mailings or “explanation of benefits” paperwork, and that he could therefore submit fraudulent bills for counseling services he claimed to have provided to dozens of SMSC members without any notice to the individuals. In reality, Jorenby never provided counseling services to those individuals, and he used their names and dates of birth without their knowledge or permission. As a result of his false billing practices, SMSC suffered a loss of at least $819,020.83.
According to court documents, in 2017, Jorenby also submitted an additional fraudulent insurance claim to State Farm Insurance following a fire at his business office. In that claim, Jorenby knowingly provided false information regarding lost income, inflating his claimed income to include earnings associated with his fraudulent billings. Jorenby received a settlement of $104,930 as a result of his misrepresentation. In sentencing Mr. Jorenby, the District Court ordered him to pay SMSC $819,020.83, and State Farm Insurance $104,930, as restitution.
https://www.justice.gov/usao-mn/pr/chanhassen-psychologist-sentenced-prison-health-care-fraud
