Dec. 09--A social worker with offices in Uniontown and Pittsburgh is accused of overbilling an insurance company by $601,280.
Lisa A. Wally, 33, a Pennsylvania licensed professional counselor whose last known address was an apartment on Biddle Avenue in Pittsburgh, is charged by the state attorney general's office with insurance fraud, theft by deception and unlawful use of a computer.
Wally, who could not be reached for comment, is expected to appear Wednesday before Uniontown District Judge Michael Metros to be arraigned on the felony charges.
According to a criminal complaint, Wally billed 22 clients' insurance companies for 9,746 office visits between January 2011 and January 2015, but actually saw the clients only 1,987 times.
In one instance, she saw a client only one time, but she submitted claims for 402 office visits, said Supervisory Special Agent Robert Gift of the attorney general's Insurance Fraud Section, Western Regional Office, in the complaint.
In another instance, Wally is accused of billing Highmark 906 times for a client she saw just 56 times.
The attorney general's office began an investigation when Highmark Blue Cross/Blue Shield noticed Wally's billings for psychotherapy services "exceeded" those of "all other licensed professionals" and she failed to submit records to back up her claims, according to the complaint.
Two of Wally's clients described the number of office visits she billed to their insurance carriers as "ridiculous," according to the complaint. Another "advised the dates of billings were incorrect and gave several dates she knew she was not there" because "she and her family were in Disney for a family vacation."
Clients are identified in the complaint by their initials only.
A client who is identified in the complaint as "A.G." told investigators her insurance company threatened to take legal action to recover $50,000 in bills Wally submitted to them.
"A.G. informed your affiant that she then contacted the actor who stated, 'I'm sorry,' and 'I did bill your insurance for every day,' " said Gift in the complaint.
Wally told the client she would "repay every dollar," according to the complaint, "but never paid any monies."
Another client, identified in the complaint as "C.M.," told investigators she confronted Wally upon learning Wally had billed her insurance carrier for visits that never took place.
Wally "told C.M. that she was in a 'low place,' 'hurting for money' and that she purchased her mother and father a new vehicle," said Gift in the complaint. C.M. told investigators Wally "also purchased a brand-new vehicle for herself, several expensive handbags and other items to include trips that she (the actor) posted on Facebook."
Special agents served search warrants on Wally's offices on West Main Street in Uniontown and Wilkins Avenue in Squirrel Hill in March, according to the complaint. In Uniontown, they found "a filing cabinet with no patient files but several empty hanging file folders with tabs for UPMC and the Department of Welfare."
At the Pittsburgh office, which consisted of a rented room above a doctor's office, they found Wally's business card, an informational pamphlet and "miscellaneous blank paperwork for clients to fill out."
Gift said in the complaint Wally acknowledged having billed insurance carriers for services she never rendered.
"The actor admitted that she did not see the patients as many times as she billed," said Gift in the complaint. "The actor advised if she and/or her husband were in need of money, 'they would just bill' because they knew certain patients' insurance would pay weekly."
A search of online criminal records turned up no criminal charges against Wally's husband, who is identified in the complaint by first name only, Jeremiah.
A phone number listed on the webpage "Lisa A. Wally Smith Counseling Services" at http://ift.tt/1M2RC77 has temporarily been taken out of service. The website indicates Wally offers services that include life and personal coaching and counseling for addiction, self-esteem issues, anxiety and depression and eating disorders.
Wally's license to practice professional counseling is active, according to an online listing through the Pennsylvania Department of State.
Liz Zemba is a staff writer for Trib Total Media. She can be reached at 412-601-2166 or lzemba@tribweb.com.
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