BATON ROUGE, La (BRPROUD) — Justice was served today in a Medicaid fraud case that involved school children at the Iberville Parish School District.
For nearly four years starting in 2011, key members at the non-profit St. Gabriel Health Clinic were submitting fraudulent claims to Medicaid totaling over $1.8 million.
St. Gabriel Health Clinic had a contract with the Iberville School District to provide medical services including, primary, preventative, dental, and behavioral health. The parents and guardians would sign consent forms to allow their children to receive health services.
According to court documents, the CEO, Victor Clark Kirk, instructed his employees to gather an entire classroom of students for “educational services” and called the sessions “character counts.” Then he instructed the COO Marilyn Antwine to bill Medicaid for the sessions and label them as “group psychotherapy.”
In 2012, Medicaid stopped the payments for group therapy sessions that the agency excludes educational services from coverage and the group sessions would need to be accompanied by an Axis I diagnosis.
In response, St. Gabriel Health Care members involved with the scheme falsely diagnosed students with serious mental disorders in order to qualify for the Axis I diagnosis and kept that information from their parents. For at least 14 students, those disorders stuck to their permanent record, according to the federal judge. The judge claimed that getting those diagnoses scrubbed from their records would be difficult and it could cause negative impacts on their lives, including preventing future employment.
The schemers submitted therapy reimbursements for students who were absent from school over 100 times.
Antwine, along with Kirk, was eventually caught and faced with several federal charges including healthcare fraud. According to Antwine’s Attorney, Steven Moore, she cooperated with the investigators every step of the way and even took a plea deal.
“The United States Government was tremendous in that part of it too,” Moore said. “They realized her cooperation and her lack of culpability in a big role so they were very, I give a lot of credit to the government for what they did.”
None of the $1.8 million ended up in Antwine’s pocket meaning that she did not financially benefit from this scheme. This was taken into account during her sentencing. But she will still have financially contribute to reimburse the government for the stolen money.
“Her continued cooperation her cooperation from the beginning of this case, I think her character and lack of any kind of prior criminal activity all those things were taken into consideration by the judge to give her a very favorable sentence.”
The judge also noted that Antwine does not have a criminal record, no evidence of drug use, and has been a hard-working citizen. She is also the primary caretaker of her disabled husband.
“She had a baby at 15-years-old, finished high school, graduated from college, got a masters degree, she’s an asset to society,” Moore said.
She was sentenced to eight months behind bars and then six months at a halfway house so that she can take care of her husband. That will begin at the beginning of January so that she can spend the holidays with her family.
“Had a very excellent judge, a very fair judge,” Moore said. “We were hoping for a little bit less of a sentence but it was more hope, I think the judge departed downwardly appropriately for the factors in the case.”
When the sentence was being delivered, Antwine’s family members were noticeably heartbroken.
“They were very upset,” Moore said. “Her two granddaughters were here, they’re pretty upset just that she’s going to have to serve a little bit of time in the Department of Corrections but I think everybody understands, she understands the judge gave her a lenient sentence but it’s still, when it comes to today it’s just still hard.”
Moore said Kirk was convicted and should be facing sentencing soon.
BRPROUD reached out to St. Gabriel Health Clinic for a statement. Their lawyer emailed their response.
“St. Gabriel Health Clinic, Inc. (“St. Gabriel”) serves low-income populations from the rural communities of East Baton Rouge, Iberville, and Ascension parishes. St. Gabriel provides culturally sensitive primary, dental, and mental health, as well as preventive health education services to the community.
St. Gabriel is aware of the allegation that have been prosecuted against Ms. Marilyn Antwine. St. Gabriel has not had any affiliation with Ms. Antwine since 2019. Since cutting all tie with Ms. Antwine, St. Gabriel has received numerous awards for their quality care. In 2022, St. Gabriel received HRSA’s (pronounced Her-Suh) Advancing HIT for Quality award and Covid-19 Public Health Champion award and a Certificate of Recognition by the American Heart Association. St. Gabriel continues to serve these communities with the highest quality of care.Attorney for St. Gabriel Health Clinic