Helena clinical counselor pleads guilty to felony Medicaid fraud

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[MM Curator Summary]: She billed for psychotherapy visits when she basically was just babysitting at bowling alleys and theme parks.


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Jessica Hayes-Cook

A licensed clinical professional counselor in Helena received a six-month deferred sentence after pleading guilty to felony Medicaid fraud for billing Medicaid for services that were not eligible for reimbursement. 

Jessica Hayes-Cook was charged on May 23, following an investigation by the Montana Department of Justice’s Medicaid Fraud Control Unit. She pleaded guilty on June 1.

Court documents note that Hayes-Cook was represented by John E. Smith of Smith & Stephens PC Law Offices in Helena. Smith could not be reached Tuesday afternoon, but another attorney at the firm said they had no comment on the case at this time.

According to an affidavit signed by Assistant Attorney General Daniel Baris, Hayes-Cook was selected to oversee supervised visits between two children and their father as the man and his wife were going through a divorce. The defendant was also selected to provide therapy to one of the children.

The supervised visits first occurred at Hayes-Cook’s office in Helena and were later held at other locations, such as Sleeping Giant Lanes bowling alley and Flying Giant Adventure Park, the affidavit says.

During an interview, the father told an agent Hayes-Cook’s role at the visits was to be present and observe while he played with his children. He said the defendant occasionally asked the children how they were doing or answered their questions when they approached her, but she did not interview the children or discuss their mental health with him.

Hayes-Cook received more than $1,500 in Medicaid payments after billing the majority of the visits to Medicaid as individual psychotherapy for the two children, the affidavit says. Observing parental visitation is not individual psychotherapy and is not billable to Medicaid, it says.

“Between October 2020 and March 2021, Defendant knowingly submitted to the Montana Medicaid program multiple misleading claims pursuant to a common scheme,” the affidavit says. “Defendant represented in these claims that she was providing individual psychotherapy to (the children), both of whom are Medicaid beneficiaries. However, Defendant was in fact providing different services which were not eligible for reimbursement by Medicaid.”

During her June 1 sentencing hearing, District Court Judge Mike Menahan ordered her to pay $2,501.82 plus $180 in fees.

The charge will be dismissed in six months if she meets the conditions of the deferred sentence agreement. As part of the agreement, she is subject to all rules and regulations of Adult Probation and Parole and is prohibited from certain activities such as gambling and possessing firearms.

Editor Jesse Chaney can be reached at 406-447-4074, or find him on Twitter: @IR_JesseChaney. 


Clipped from: https://helenair.com/news/local/crime-and-courts/helena-clinical-counselor-pleads-guilty-to-felony-medicaid-fraud/article_296e4c18-9274-5af2-9cfe-e196de358988.html