An Ormond Beach mental health counselor is out of jail on bail after spending two days in lockup on charges she bilked Medicaid of more than $200,000 for services she never rendered, court records reviewed on June 22 show.
An investigator with the Florida Attorney General’s Office said Venessa Thomas, 38, used the money to travel, visit medical spas, and to buy luxury and designer goods.
Thomas was booked into the Volusia County Branch Jail on June 18 on charges of Medicaid fraud, organized scheme to defraud over $50,000, use of identification of a child less than 18 years of age, and offense against a computer user. Jail records showed that Thomas was out on $37,500 bail.
Thomas was arrested after an investigator with the Florida Office of the Attorney General/Medicaid Fraud Control Unit filed a charging affidavit stating that Thomas defrauded Medicaid of $219,787.13.
The investigator said that the affidavit did not include everything known to law enforcement, but highlighted those necessary to establish probable cause to arrest Thomas.
Ormond mental health counselor billed Medicaid for ‘impossible days’ investigator said’
According to court documents, the Florida Attorney General’s Office started investigating the Medicaid fraud in March 2024 after the Sunshine Health Investigation Unit flagged Thomas’s business, A Better Life and Community LLC, for filing “impossible days”claims.
“Impossible days” were when Thomas billed for services that could never be completed in 24 hours.
On April 28, 2024, Thomas filed claims for services she provided to 49 Medicaid patients. According to codes Thomas used, 43 of the claims were for 60-minute sessions and six were for 26-minute sessions. When investigators examined the claims, they showed Thomas billed for more than 40 hours of psychotherapy services she said were rendered in a 24 hour period, the report said.
Thomas was paid $5,525.94 for April 28, the report states.
Thomas filed numerous “impossible days” claims — approximately 200 — for which she got paid by Medicaid, the state investigator said.
Some of these “impossible days” included claims Thomas made providing services to patients on numerous weekends and holidays, including July 4, Sundays, Easter Sunday, and Thanksgiving and Christmas, the report said.
“Your affiant (investigator) knows from prior investigative experience that analyzing claims data submitted by a Medicaid provider for services purportedly provided on weekend days and holidays can be an indication of fraudulent activity,” the investigator wrote in the report.
‘Back-billing’ was part of Ormond mental health counselor’s Medicaid fraud, court records show
Thomas also carried out a back-billing process that allowed her to make claims on services she never gave, court records show.
Under Medicaid policy, Thomas was allowed to file claims up to one year after providing service to patients. But investigators said Thomas filed a high number of claims on a single day. On Dec. 8, 2023, Thomas filed 772 claims for six patients, services she said she gave between Nov. 15, 2022 and Nov. 29, 2023, the report detailed.
State investigators said they also discovered that Thomas billed some patients for services nearly every other day.
Thomas also created fraudulent appointments that bypassed the use of the telehealth portal and filed claims for which she got paid, investigators said.
Ormond mental health counselor accessed Medicaid computers to find ‘phantom patients,’ report said
State investigators said that as a Medicaid service provider, Thomas was assigned a unique 9-digit number that gave her access to Medicaid computers. The investigation concluded that she went into the system to find names of people, and then using their names, billed for services she never rendered, the report said.
These were “phantom patients,” used for “phantom billing,” the report said.
Some of the phantom patients were as young as 7 years old, the report showed.
In one instance, Thomas billed for services she supposedly provided to a patient who lives in Georgia. The mother of that patient told the investigators she did not know Thomas and never received services from her, the report said.
Thomas violated her privileges by accessing Medicaid computers more than 2,700 times to get patients’ information, the state investigator said.
“Thomas was conducting a systematic search to obtain sufficient information on patients to perpetuate her phantom billing scheme,” the investigator wrote in the report.
Ormond mental health counselor used Medicaid fraud money on herself, report states
In the charging affidavit, the state investigator said Thomas spent a considerable amount of money from the fraudulent Medicaid claims on travel, medical spas, as well as to buy luxury or designer goods.
Investigator documented that Thomas spent $175,815.76 in medical aesthetics, skin care and dermatology that included $23,403.13 spent at La Jolie Skin Care in Honolulu, Hawaii. Thomas also shopped at a high-end boutique, Christian Louboutin, where she spent $12,566.98, the report detailed.
―Reporter Patricio G. Balona writes crime and public safety stories for the News-Journal, covering Volusia County and areas like Daytona Beach, DeLand, Ormond Beach, and more
This article originally appeared on The Daytona Beach News-Journal: Ormond counselor defrauded $219K from Medicaid, records allege
Reporting by Patricio G. Balona, Daytona Beach News-Journal / The Daytona Beach News-Journal
USA TODAY Network via Reuters Connect
By Patricio G. Balona, Daytona Beach News-Journal | USA TODAY Network
