NORTHAMPTON — A former Easthampton-based social worker pleaded guilty on Monday to committing more than $100,000 in insurance fraud over a five-year period.
In Hampshire Superior Court, Kathleen D. McGovern, 64, of Northampton, changed her plea from not guilty to guilty on one charge of making false statements in applications for payments of health care benefits and one count of larceny over $250. She was sentenced to three years probation.
McGovern was accused of fraudulently billing the insurance company Health New England for more than 1,000 therapy sessions she never actually conducted with 38 different people, some of whom had been clients and others who had no connection to McGovern.
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.
The district attorney’s office first began investigating McGovern after one 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, Gagne said. The DA’s office eventually referred the case to the state’s Insurance Fraud Bureau.
Gagne asked that Judge Richard Carey sentence McGovern to 18 months in jail. He said that stealing from a large corporation should not be taken likely, and he said 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, as Gagne suggested people from his own office had done.
“They play by the rules and do what it takes to get by,” he said.
However, McGovern’s attorney, David Hoose, described McGovern as somebody who was struggling with health problems after having lost several jobs in the field. As McGovern was just getting her business started in Northampton, Hoose said, HNE slashed reimbursement rates by 40 percent.
“It was in that frame of mind that she came to the point where she made the decision to do this,” Hoose said.
Both the prosecution and defense said that McGovern has used the money from the fraud to pay her bills.
Hoose asked Carey to impose restitution and probation, and not the jail sentence that the state requested.
Carey ultimately placed McGovern on three years probation with several conditions: that she not engage in counseling services, that she not contact the 38 people whose names she used in the scheme, that she undergo mental health evaluation and treatment and provide four hours of community service per week during her probation.
This story has been updated to reflect the fact that McGovern was sentenced to three years probation.
Dusty Christensen can be reached at dchristensen@gazettenet.com.