CT psychologist was under supervision while committing Medicaid fraud

A Connecticut psychologist recently sentenced for committing roughly $1.6 million in Medicaid fraud between the years 2017 and 2023, was placed on probation by the Connecticut Board of Examiners in January of 2017, according to license records, and was under supervision for one year while defrauding Medicaid.

A complaint was made to the Connecticut Department of Public Health (DPH) against psychologist Michael B. Pines when he was assigned by a family court judge to treat three children caught in a contentious divorce case.

According to the complaint, Pines had not developed individual treatment plans for the children, failed to coordinate with other mental health providers, failed to obtain consent from the father for treatment, failed to justify a treatment course after more than three years of treating the children, and was submitting billing codes “that were not indicative of the therapy provided.”

Under questioning by attorney Norm Pattis during a 2012 deposition, Pines estimated he’d seen the children 70 times between 2009 and 2012 but had made very little progress. Instead, the children’s relationship with their father had “deteriorated” and Pines was offering his opinion that the children should not be compelled to see him during visitation.

Pines also admitted to rarely communicating with the reunification therapist, who, according to the deposition, said that the children did not need therapy with Dr. Pines. Pines stated he had no concerns about the mental health or well-being of the children, outside of their refusal to see their father.

Pattis questioned Pines as to whether seeing the children only once per month at that point was effective, saying Pines was “content to just doodle along,” with continuing therapy.

The complaint against Pines was submitted to DPH in 2012, but the process took years including an investigation by a DPH consultant. The Board of Examiners placed Pines’ license on probation in January of 2017 for “failing to adequately document treatment plans,” — the same time the U.S. Department of Justice says Pines was defrauding Medicaid.

Pines did not contest the probation but also did not admit guilt, according to the consent decree, which required him to obtain the services of a psychologist approved by the DPH who would be his “supervisor” and conduct a quarterly review of 20 percent of Pines’ records selected at random, meet with him quarterly, and monitor his practice.

The supervisor would then provide reports to Pines, who was then to submit those reports to DPH. Pines was also ordered to “attend and successfully complete coursework in documentation standards, pre-approved by the Department.”

It was during that same time of supervision – 2017 – that Pines saw 110 Medicaid patients, logging 3,041 visits, and billing $343,281 to Medicaid, according to the search warrant affidavit , which found a total of $2.3 million in Medicaid payments to Pines between 2017 and 2023. Also in 2017, Pines made a trip to St. Martins for vacation, yet continued to bill Medicaid for visits during his vacation time.

According to the sentencing memorandum, in 2017 Pines was regularly billing Medicaid for 12 to 16 hours of service in a single day, five days per week. One comparison to his peers found that he was the highest-paid psychologist in Connecticut’s Medicaid system, receiving $1.1 million between January 2020 and May 2023, compared to $405,000 for the next highest-paid psychologist.

The fact that Pines also saw private pay clients during this same time was cited by federal authorities as further proof of the Medicaid fraud – there simply weren’t enough hours in the day for both. While the DOJ only investigated between 2017 and 2023, Pines had been seeing Medicaid patients since 2014. The federal statute of limitations for Medicaid and Medicare fraud is five years.

Reached for comment via email, DPH Spokesman Christopher Boyle said the supervision was limited to Pines’ documentation and did not include his billing practices.

“The supervisor was required to provide reports to the Department that included a general description of the patient records and whether or not he was practicing with reasonable skill and safety,” Boyle said. “The quarterly reviews focused on Pines’ documentation and practice of psychology, and did not include a review of billing practices as there were no allegations of fraudulent billing at the time.”

Pines received numerous letters of support from fellow psychologists, attorneys, clergy, guardian ad litems, and the former Child Advocate and Superior Court Judge Linda Pearce Prestly who all praised his professionalism, generosity, honesty, and integrity, and argued the fraud was out of character, urging the court to be lenient.

Executive director of The Children’s Law Center of Connecticut Justine Rakich-Kelly, wrote in support of Dr. Pines, indicating that he had worked with many of their children who were on Medicaid, and lamenting that he would no longer be available.

“Dr. Pines provides a vital service to the children and the professionals helping children in this state,” Rakich-Kelly wrote. “We struggle to find providers willing to take HUSKY and it is a huge loss to our clientele that Dr. Pines will no longer be available to them.”

Pines’ attorney argued that Pines suffered from “a high level of anxiety” and “a whole range of cognitive distortions” motivated by an “intense fear of failure,” leading him to violate “his own personal high standards, as well as the law.”

The government, however, did not see it the same way, according to the sentencing memorandum . “The government believes that, in the absence of any addiction or serious mental condition, greed fueled this opportunistic crime,” U.S. Attorney Vanessa Roberts Avery wrote. “This scheme was not an aberration or a lapse in judgement; it was his way of life.”

The U.S. Attorney described a lavish lifestyle lived by Pines, including supporting his son’s mortgage in Tampa, Florida, tens of thousands in jewelry purchases and salon visits, and numerous vacations.

“Pines lived an expensive life, one that he could not have afforded absent his fraud,” Avery wrote. “Moreover, he was unwilling or unable to work more than he actually did. Rather than change his lifestyle to fit his financial circumstances or work more to support it, Pines chose instead to cheat Medicaid.”

The Connecticut Department of Social Services (DSS) asked that Pines be punished to the full extent of the law to set an example for others on the consequences for cheating Medicaid meant for low-income families.

“In addition to paying full restitution as part of his plea, the Department requests that the Court order the maximum sentence available under the law for the Defendant,” wrote DSS Deputy Commissioner Shantelle Varrs. “A significant sentence will send the message that using fraudulent means to obtain funds from the Department and jeopardizing the health and well-being of our clients, is inexcusable and will not be tolerated.”

The 75-year-old Pines was ultimately sentenced to 27 months in prison, followed by three years of supervised release on May 10, 2024, and to make full restitution of the $1.6 million. Pines had also already paid back $550,000 before his sentencing.

The probation period for Pine’s license ended in February of 2018, with Pines having satisfied the terms of his disciplinary action. The father in the contested family court case who lodged the complaint against Pines reportedly attended the sentencing.

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