November 14, 2018
 
Northampton Woman Pleads Guilty to Defrauding Nonprofit

October 30, 2018 — A Northampton social worker pleaded guilty in Hampshire Superior Court on Monday to defrauding Health New England, a Springfield-based nonprofit health plan, to falsely billing the organization for $125,000 in connection with more than 1,000 counseling sessions that never occurred.

Kathleen D. McGovern, 64, of Northampton, pleaded guilty to one count of making false statements in connection with applications for payment of health care benefits, and one count of larceny over $250 in connection with the fraudulent billing of Health New England (HNE) over a five-year period for counseling services she did not provide, according to the Office of Northwestern District Attorney, which serves Hampshire and Franklin counties and the town of Athol.

Judge Richard Carey ordered her to serve three years' probation with multiple conditions, including that she not offer counseling services, have no contact with people whose names she used to fraudulently bill the insurance company, that she undergo mental health evaluation and treatment and that she provide four hours of community service per week during the period of her probation, the DA's office said.

McGovern admitted to billing the insurance company for more than 1,000 counseling sessions that never occurred, using the names of 38 people, some of whom she didn’t know but had found online, between June 1, 2011 and June 1, 2017, when her scheme came to light, according to the DA's office.

The Daily Hampshire Gazette reported: "Because no Social Security number or date of birth was required to bill HNE for a therapy session, and because HNE did not send an explanation of benefits to the people McGovern said she had given therapy, the scheme went undetected from between June 2011 and June 1, 2017, according to First Assistant Northwestern District Attorney Steven Gagne.

"Many of the names McGovern used were employees of the City of Northampton, whose names could be easily found online, according to Gagne."

According to the Gazette, the DA's district attorney’s office began investigating McGovern after a person, whose name McGovern used to falsely bill HNE, logged onto his health insurance account and noticed sessions with McGovern, whom he had never met.

Northwestern District Attorney Steven Gagne reportedly asked McGovern to be sentenced to 18 months in jail, noting, according to the Gazette, "that HNE pointed to such fraud as a reason for health care costs increasing. Gagne suggested that if she were facing financial hardship, McGovern could have gotten a second or third job."

According to the DA's office, McGovern defrauded the insurance company of more than $100,000. MassLive reported that the fraud amounted to $125,000.

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