Five indicted in multi-million dollar mental health fraud conspiracy after records didn’t add up
Five people in Georgia—including two election officials with a county government—have been indicted by a federal grand jury on charges of orchestrating a multi-million dollar healthcare scheme.
An unsealed indictment names Dawn James-Ellis, Angela Childs, Adrian Harris Lamonica Lakes and Tarshea Fudge-Riley as defendants, all facing charges of conspiracy to commit healthcare fraud.
Fudge-Riley and Lakes are employees with the Macon County Board of Elections.
All five pleaded not guilty when they appeared before a federal judge this week. The case against them involves the alleged submission of fraudulent medical claims to insurers for mental health services that were never delivered.
Prosecutors have accused James-Ellis, a licensed therapist, of billing Cigna, Aetna and other companies for mental health counseling sessions that never happened. As part of the conspiracy, the other defendants were allegedly willing accomplices, who served as would-be patients to have their insurance billed.
James-Ellis, who also faces a charge of identity theft, would allegedly send kickbacks to the others after she received payment from health plans.
To cover her tracks, it's alleged she had the “patients” create session notes to solidify the idea that services were delivered through James-Ellis’s practice, called Therapy on the Go.
Authorities maintain that the fraud scheme involved millions of dollars exchanging hands, but no specific figure was revealed. For now, the case is in its early stages, and facts allowed at trial will be decided during future hearings.
It’s believed incidents of fraud spanned nearly four years. The indictment claims the conspiracy began in January 2019 and ended sometime in December 2022.
Unrealistic record-keeping
In some of the instances noted by prosecutors, more than 24 hours a day were billed to insurance for the delivery of mental healthcare, which if true, would be impossible.
Other therapy sessions were said to have occurred on holidays and weekends, when James-Ellis was on vacation.
In addition to billing commercial healthcare payers, it’s alleged that public health programs designed to facilitate treatment were also scammed out of funds.
This is a developing story. The accused remain innocent until proven guilty beyond a reasonable doubt.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.