The state attorney general's office has charged a former case manager in Luzerne County with billing Medicaid for hundreds of non-existent therapy sessions with dozens of emotionally troubled children.
The office also charged a former Lycoming County mental health therapist with sexually exploiting a female client during sessions and fraudulently billing Medicaid.
“These cases are not instances of mistaken billing — they involve providers who were criminally unprofessional, and in some cases, predatory, towards people they were trusted to care for,” Attorney General Dave Sunday said in a statement Tuesday.
Michael Erik Miller, 36, of Williamsport, the therapist in the Lycoming case, and Khalil Rashid Rivera, 30, of Scranton, the manager in Luzerne, are free on unsecured bail.
Statewide grand jury
Rivera submitted almost 1,300 fraudulent claims involving dozens of children between March 2019 and August 2022, according to the findings of a statewide investigating grand jury.
Concerns arose in January 2023 after one family told the Children's Service Center of Wyoming Valley they had not seen Rivera in more than a year, the Attorney General's Office said.
Rivera, a blended case manager for the agency, connected children with mental illnesses or emotional disorders with appropriate treatment. He was assigned 68 clients.
Children's Service Center officials reviewed medical and billing records and the agency’s ID badge system and interviewed clients’ guardians. They found Rivera billed Medicaid for face-to-face contact at clients' homes or in the community when he was actually in the office, according to the presentment.
He copied and pasted many progress notes into multiple clients’ files, according to the grand jury.
In one case, Children's Service Center records show Rivera filed the same progress note for a client on May 10, 2022, and July 15, 2022.
"Despite the fact that he had not provided service to [the client] since Christmas 2021, Rivera submitted progress notes and billed for telephone and face-to-face services on 12 occasions from Jan. 17, 2022, until June 15, 2022," the grand jury's findings state.
Nine were face-to-face, three by telephone, he reported.
The client's father told investigator Ryan King that Rivera began working with his son when the boy was 3 years old and visited their home at least an hour every other week.
After a while he visited once a month, then once a quarter “until around Christmas 2021 when he stopped contacting the family entirely,” the presentment says.
The father said King brought five or six blank encounter forms for him to sign each time he visited. He told the family “he would just fill in the dates on the forms at a later time," the grand jury reported.
The forms help document service for billing Medicaid.
The center found encounter forms missing for 217 of Rivera's billed client encounters with clients and blank forms either signed by clients or guardians or dated with no signature, the grand jury said.
Key to investigation
Phone records were key in the investigation, according to court documents.
Billing was required in 15-minute intervals, with blended case managers only allowed to bill for encounters lasting eight minutes or longer.
Rivera used his personal phone for work calls. A review of his call records showed he billed for:
- 2,433 units of service for phone calls he never made.
- 563 units for calls under the threshold.
He also overbilled for 591 units longer than he actually worked.
The fraudulent billing totaled more than $72,000.
Rivera faces three counts of submitting fraudulent claims, two counts of tampering with public records, and one count each of filing a false Medicaid assistance claim and theft, all felonies.
Sexual extortion included in charges
In the Lycoming case, Miller earned $30 an hour as an unlicensed therapist for Lycoming Therapeutic Wraparound Services Inc., of Williamsport, from April 13, 2020, until he resigned under pressure in April of last year.
He went through training sessions that warned against using illegal drugs and sexual contact with clients and texting or emailing them, then did all that with a female patient, according to the affidavit.
The woman started seeing him in July 2023 for therapy for “borderline personality disorder and a history of sexual trauma.”
Miller flirted with her “right from the start” of the first of their 59 sessions, according to an arrest affidavit filed by supervisory special agent Jennifer E. Snerr.
The flirtation evolved into telling her about his own relationships with “intimate sexual details” and his sitting or lying close to her during therapy sessions. He asked ask permission first, then say he felt “guilty” about doing it, then move away, but return, according to the affidavit.
He grew more “touchy” in later sessions, “slowly being less of a therapist,” the woman told Snerr.
“They would sit next to each other, and her legs were on (Miller’s) lap and he would touch and rub her legs,” the affidavit says.
At one session, he pulled down her leggings and touched her vagina as she questioned her sexuality by saying, “I don’t like men.”
“He told her the ‘right guy’ hasn’t come around, and he could ‘change her mind,’” Snerr wrote.
On Jan. 15, 2024, Miller went to her house for a session, an unethical act, according to the affidavit. That day, they smoked marijuana that he bought from her and showered together, and he attempted oral sex while both were high, according to the affidavit.
“(She) asked (Miller) if her insurance was paying for that day at her home. He told her yes,” the affidavit says.
Investigators showed her his therapy note for the visit. The note was just a summary about her that praised her school progress, even though “she was failing school terribly.”
Miller became 'oddly jealous'
When she relayed her past “non-consensual” experiences with men, Miller became “oddly jealous.”
“She told him that was weird since the experiences she spoke to him about were not good ones,” Snerr wrote. “Pretty often, (Miller) told (her) that he felt like he was ‘taking advantage of her’ and he felt ‘guilty’ and his behavior was ‘wrong.’ He told her not to tell anyone about them because he didn’t want to go to jail.”
At their last session, Feb. 16, 2024, he asked her to have sex. She “just froze” and became scared when he tried.
“Seeing that, (Miller) said, ‘OK, time’s up’ and kept asking her to go,” the affidavit says. “(She) said that she was crying when she ran out of the office after that last appointment.”
He kept trying to call her, but she ignored him. Eventually, she told her new therapist, who reported his misbehavior to superiors.
She feared Miller would drop her as a client if she didn’t let him touch her, she told Snerr.
The agency received $7,086.60 from Medicaid for what Miller reported as therapy he provided to the woman.
Miller confessed the sexual contact with the woman when Snerr interviewed him Feb. 14, according to the affidavit. He said the woman came to him for therapy for an eating disorder, trauma from unwanted sexual contact and assault, depression and chronic thoughts of suicide.
He is charged with four counts of Medicaid fraud, two counts of sexual extortion and single counts of tampering with records and theft.
