Date: 11-25-2019

Case Style:

Case Number: 1:19-cr-00175-TH

Judge: Zack Hawthorn

Court: United States District Court for the Eastern District of Texas (Jefferson County)

Plaintiff's Attorney: Christopher T. Tortorice

Defendant's Attorney:

Call 918-582-6422 if you need help finding a criminal defense lawyer in Beaumont, Texas for representation on a health care fraud charge.

Description: Beaumont, TX - The United States of America charged Douglas Duane Franklin with health care fraud.

A 59-year-old Beaumont mental health care counselor has pleaded guilty to health care fraud in the Eastern District of Texas.

Douglas Duane Franklin pleaded guilty to an Information charging him with health care fraud.

According to information presented in court, since 2007, Franklin has been the owner and sole provider at Guiding Light Counseling Service, PLLC, where he provides mental health counseling services, for which he bills Medicaid, Medicare and private insurance. Between 2007 and 2019, Franklin was reimbursed $591,600.69 for three different time-based counseling CPT codes, all in durations of 30 minutes or more. Medicaid rules require that the indicated time is spent face-to-face with the patient, and expressly does not include time for documentation or other administrative activities. Between 2007 and 2019, Franklin submitted over 10,000 claims for visits exceeding 30 minutes or more.

During the course of a months-long investigation, investigators with the US Attorney’s Office, the FBI, HHS-OIG, and the Texas Attorney General’s Medicaid Fraud Control Unit discovered that Franklin had patient sessions scheduled in 30-minute increments, some of which were double-booked. However, out of the 10,215 claims submitted by Franklin, only one was for a 30-minute visit. All of the remaining visits were billed under the 45-minute or 60-minute CPT codes, which provided for an increased reimbursement rate. Franklin was paid a total of $591,600.69 for all claims under the previously described CPT codes, when he was only entitled to receive $321,772.50. As a result of Franklin submitting fraudulent claims, he was overpaid $269,828.19 by Medicaid.

Under federal statutes, Franklin faces up to 10 years in federal prison at sentencing. The maximum statutory sentence prescribed by Congress is provided here for information purposes, as the sentencing will be determined by the court based on the advisory sentencing guidelines and other statutory factors. A sentencing hearing will be scheduled after the completion of a presentence investigation by the U.S. Probation Office.

This case is being investigated by the Federal Bureau of Investigation, HHS-OIG, and the Texas Attorney General’s Medicaid Fraud Control Unit.

Charge:

HEALTH CARE FRAUD (CRIMINAL FORFEITURE)
(1)

Outcome: 11/15/2019 INFORMATION UNSEALED as to Douglas Duane Franklin (tkd, ) (Entered: 11/15/2019)
11/15/2019 4 Minute Entry for proceedings held before Magistrate Judge Zack Hawthorn: INITIAL APPEARANCE, ARRAIGNMENT and PLEA HEARING as to Douglas Duane Franklin (1) held on 11/15/2019. Plea entered: Guilty on Count 1. Deft released on personal recognizance bond. (Court Reporter T Piper.) (tkd, ) (Entered: 11/15/2019)
11/15/2019 5 WAIVER OF INDICTMENT by Douglas Duane Franklin (tkd, ) (Entered: 11/15/2019)
11/15/2019 6 E-GOV SEALED Personal Recognizance Bond Entered as to Douglas Duane Franklin (tkd, ) (Entered: 11/15/2019)
11/15/2019 7 E-GOV SEALED ORDER Setting Conditions of Release as to Douglas Duane Franklin (1). Signed by Magistrate Judge Zack Hawthorn on 11/15/19. (tkd, ) (Entered: 11/15/2019)
11/15/2019 8 Waiver and CONSENT to Proceed Before U.S. Magistrate Judge for entry of guilty plea by Douglas Duane Franklin (tkd, ) (Entered: 11/15/2019)
11/15/2019 9 FACTUAL BASIS and Stipulation by USA as to Douglas Duane Franklin. (tkd, ) (Entered: 11/15/2019)
11/15/2019 10 SEALED PLEA AGREEMENT as to Douglas Duane Franklin (tkd, ) (Entered: 11/15/2019)
11/15/2019 12 FINDINGS OF FACT AND RECOMMENDATION on Plea of Guilty as to Douglas Duane Franklin. Signed by Magistrate Judge Zack Hawthorn on 11/15/19. (tkd, ) (Entered: 11/18/2019)
11/15/2019 13 E-GOV SEALED Summons returned executed on 11/13/19 as to Douglas Duane Franklin (tkd, ) (Entered: 11/18/2019)

Plaintiff's Experts:

Defendant's Experts:

Comments: