Arizona mental health counselor Kathleen Exelby disciplined for numerous instances of fraud

February 28, 2011

On November 4, 2010, the Arizona Board of Behavioral Health Examiners placed licensed professional counselor Kathleen Exelby on probation for numerous instances of fraud, including, among other things, the following:

• Consistently used one progress note to document 90-minute sessions that included a client and one or more family members, which Exelby billed twice: once as an individual session and once as a family session though her notes did not indicate how much time she spent individually with one client or the amount of time spent with the client and family together.
  
• Submitted insurance claims for a significant number of session where the clients advised the insurance company that these session never occurred. 
  
• Instances of client records which did not include a progress notes for sessions she claimed to have provided and in other instances, she had a progress note for session she claimed to have provided but she did not have the client sign the first page of the progress note, as was her usual practice.
  
• Submitted a claim for a session that occurred more than one month after her client record indicated the client terminated treatment.
  
• Her clinical records contained a significant number of alterations in which she used white-out to delete information previously recorded.  In some instances, she deleted a previous date on a progress note and then wrote a new date. 
  
• Submitted progress notes to Ingenix (a health information technology company) which were not the same notes she maintained in her original record for that date.
  
• Submitted claims for individual and family therapy where a majority of the sessions provided were marital therapy sessions where marital therapy was not a covered service.
  
• Submitted claims using the 90809 billing code—the designation for individual psychotherapy combined with a medical evaluation and management services, which are not within the scope of Exelby’s practice.
  

Terms of her probation include 24 months clinical supervision and a practice audit.

Source: Arizona Board of Behavioral Health Examiners Adverse Action Tracking Form, December 2010.