Counselor jailed for Medicaid fraud

A counselor who repaid the state nearly $28,000 for sessions that didn't happen will serve three months in jail for fraud.*

Judge Vince Foley told 42-year-old Shawn Nills that his crime would have been worthy of a prison sentence, but the counselor's lack of a criminal record and the presumption of probation carried by the nonviolent felony charge tied his hands.

"But for the legislature, I'd send you to the pen," Foley told Nills Thursday at the Lake County courthouse.

Nills received a five-year prison sentence, suspended on the condition he commit no crimes new crimes and pay his fines. He'll also be barred from accepting Medicaid or Medicare clients for five years, and could lose his state counseling license.

Nills' sentencing had been set for May 1, but Foley refused at that time, saying that statements made during a pre-sentence investigation contradicted the facts presented by the state. Nills submitted an amended admission of guilt at the start of Thursday's hearing.

Suspicion of fraudulent billing bubbled up in early 2014, according to Assistant Attorney General Paul Cremer. A family with private insurance got an explanation of benefits outlining payments made for a counseling session that never happened.

When Nills' employer, Community Counseling Services of Madison, heard about it, their billing department began to comb through records to see if there were problems with its billing software.

They only found problems with Nills' records. He'd billed for sessions with several clients who'd been marked as "no shows" in CCS notes.

He was first suspended, then fired in the Spring of 2014.

Last summer, when investigators began asking Nills questions about claims, he'd say that he provided the services, but that he'd do so outside the facility. He'd play Wii with a client or tie fishing lures, he said.

"He misled us for several months," Cremer said. "He was very cordial, but he was not cooperative."

Nills' lawyer, Jay Libel, told Foley his client wasn't in a position to answer those questions. He didn't have any records at that time. He also noted that Nills had fully repaid the state for the claims by the time of his initial sentence hearing.

The counselor told Foley he was sorry for his mistakes, and that he knew they were more than simple errors.

"I knew what I was doing was wrong and I did it anyway," Nills said. "My actions have cost me everything."

He also apologized for the shame his actions have heaped on the field of behavioral health.

"My actions have cast negative light on the work that we do," he said.

Nills had asked for a suspended imposition of sentence, which would have wiped his record clean for good behavior, but Foley said that hadn't been earned yet.

Nills now has seven days to turn himself in and begin serving his jail sentence. The investigation uncovered $9,226.74 in fraudulent bills. He repaid $27,680.22 in damages as part of his restitution.

* Correction, June 12: An earlier version of this story stated that Nills had overcharged the state by nearly $28,000