LICENSED PSYCHIATRIST RECEIVES 18 MONTHS FOR FALSELY BILLING MEDICAID 1.7 MILLION DOLLARS

Attorney General J. Joseph Curran, Jr., announced today that Dr. James An Nguyen, 68, of 4300 block of Mary Ridge Drive in Randallstown, received a sentence of five years, suspending all but 18 months, after pleading guilty to facilitating the submission of almost 1.7 million dollars worth of false billings to the Medicaid program.

Nguyen is a licensed psychiatrist, and was approved by Medicaid to bill for therapy services he personally rendered. Medicaid regulations prohibit a psychiatrist from billing under his own provider number for services rendered by anyone other than the psychiatrist. According to Office of the Attorney General prosecutors, in October 2002, Nguyen entered into an agreement with The Bridges Project, LLC (“TBP”), which was a provider of unskilled counseling services to eligible Medicaid recipients, mostly children, in the Baltimore area. Pursuant to that agreement, from November 2002 until March of 2004, Nguyen allowed TBP to use his individual provider number to bill for more than 18,000 therapy sessions that he neither provided nor supervised. Instead, those services were purportedly provided by mostly unlicensed social workers hired by TBP. In exchange for improperly allowing the company to use his provider number, Nguyen received approximately 20% of the amount Medicaid paid for each therapy session billed under his number by TBP.

As a result of that arrangement, Nguyen received about $340,000 of the $1,699,809 Medicaid paid in response to claims illegally filed under his provider number, with the rest going to TBP.

As part of his sentence, Baltimore City Circuit Court Judge Wanda Heard also required Nguyen to pay $305,000 in restitution. Pursuant to a plea agreement with the State, Nguyen has presented the State with an initial payment of $100,000 toward that amount. The rest is to be paid over the five-year period of supervised probation ordered by Judge Heard.

During its investigation of the relationship between Nguyen and TBP, the Attorney General’s Office also discovered that for much of the time that TBP was billing for therapy services using Nguyen’s number, the company lacked enough therapists to see all the patients for whom it was billing. At one point, TBP was billing for weekly therapy services purportedly provided to as many as 300 children to whom it had not yet even assigned a therapist. “Although the amount of money stolen from the State by Dr. Nguyen is startling, what is most upsetting is that his deception essentially prevented 700 Baltimore City children from receiving the therapy they needed. Our children deserve better,” said Attorney General Curran.

The case was prosecuted by the Medicaid Fraud Control Unit (MFCU) of the Maryland Attorney General’s Office. The MFCU conducted the investigation with assistance from the Mental Hygiene Administration (MHA), which suspended payments to Dr. Nguyen in March of 2004. MHA has been working with the MFCU to root out fraud in its programs, and several cases of fraudulent behavior by MHA providers have been successfully prosecuted by the Attorney General’s Office.

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