Fraud Incident Report

[The following is a relative draft of the healthcare fraud investigation I am leading. I wanted to be able to publish my website in order to prioritize my self-expression before moving forward with submitting reports to official authorities. I did report the suspected fraud to United Healthcare. As I finish sorting through evidence and documents, I will update them on the website.

Update: Originally we had indicated that we suspect Marla LaRock as a perpetrator of fraud; however, after our shock and anger subsided and we were able to reflect, we confidently believe Marla LaRock to be innocent. We have adjusted this draft to reflect those changes.]

My name is Danielle Paul and after reviewing my health records associated with Shore Counseling and Consulting Clinic, I have reason to believe that I am a victim of healthcare fraud and abuse. 

I was a client of Shore Counseling and Consulting Clinic from 2016 until 2022. Despite requesting my records, they were withheld from me for over three months and then they were not complete. The records I have available are from January 2020 through February 2022. 

• There are no billing records associated with Diane O’Donnell during the time that she was my therapist (from August 2020 - January 2021). I do not know if Diane O’Donnell was billing medicare at all as a therapist or nurse practitioner. I was not provided with any records associated with medicaid despite my request.

• Fifteen claims were found submitted under the name Ellen Reid, who I did not receive services from at Shore Clinic. 

• The claims submitted under the name Ellen Reid are all associated with dates of service with Marla LaRock. 

• I discovered multiple claims submitted on the same date of service under the name Marla LaRock. Each claim was denied with the reason given as inconsistent billing code and many codes did not reflect a diagnosis that I was given or treated for. For each date of service, a claim was filed under the name Shore Counseling and Consulting Clinic to be processed successfully. At this point I have found 177 claims following this pattern. 

• Shore Counseling and Consulting Clinic failed to provide any records associated with medicaid. 

• There were many claims submitted using the diagnostic code F942 for many of the denied claims. This code is not associated with a diagnosis that I have. However, the symptoms that I expereinced were relatable so initially I did not question the billing code; I believe that this was intentional.

  
  

• On 10/01/2022, there are multiple claims submitted under the name Marla LaRock despite not having received services from her on that date. 

  
  

• On 11/25/2020, there is a late cancellation fee associated with services with Marla LaRock, but I never received services with her on that date. 

Before uncovering evidence of fraud, I had been harmed at Shore Counseling and Consulting Clinic and I now believe that many instances of abuse also constitute healthcare fraud. 

During the time that I was a client of Diane O’Donnell, I was prescribed medications that were not medically justified, resulting in consequences to my health. The medications I was prescribed did not improve my symptoms. I experienced side effects that decreased my quality of life and led to damaging harm, including: severe weight gain as well as weight loss, malaise, fainting, dehydration, kidney pain, toxic levels of lithium found in blood. When I requested to lower the dose of my medication, Diane refused. 

At my request, Diane refused to refer me to a psychiatrist for an evaluation, insisting that I was in denial about having bipolar disorder. However, she was not qualified to provide a diagnosis as a Psychiatric Nurse Practitioner or as a Licensed Practiced Counselor. (Since leaving treatment with Diane O’Donnell, I have been able to officially validate that I do not have bipolar disorder and my record has been updated to reflect this.)

I believe that Diane was meant work under a provider licensed to prescribe and I have this far had difficulty identifying that provider.

Diane continued to prescribe my medications for 6 months after I quit services with her, despite my intention to take myself off of my medications.

In 2018, I was subjected to multiple sessions of electro-convulsive therapy, which I later learned was unnecessary and ineffective for my condition. Although I consented to treatment, I was pressured to do so. Both Marla and Diane recommended ECT during the same week and Diane told me that if I did not agree to ECT, that she would no longer be willing to see me as a patient. ECT caused severe impairment in my functioning and I became disabled and unable to work. In hindsight, I believe that I was manipulated into making the decision to participate in ECT treatment.  

In 2020, Diane became both my psychiatric nurse practitioner as well as my therapist, but she was treating me for bipolar disorder as a nurse practitioner and treating me for trauma as a therapist. She was using each diagnosis to her advantage but not in a way that was helpful for me. For example, withholding my anxiety medication if I did not agree to therapy or denying my symptoms related to trauma in order to justify medicating me for bipolar disorder. 

After quitting therapy with Diane, I went back to therapy with Marla, but when I disclosed the abuse that I experienced, I did not feel believed which made me question if I trusted Marla. After leaving the shore clinic and having space to recover and finding a new therapist, I have been able to process my experiences with both Diane and Marla and it is my personal opinion that Marla LaRock did not cause me intentional harm.

Currently, I am investigating this theory with space to be wrong. Because my recordss were witheld, not kept confidential, and not complete, it is a very difficult project to work on, but we do have a few ideas on how we can use logic to discover the truth.

I quit therapy with Marla LaRock in February of 2022, ending all services at Shore Counseling and Consulting Clinic and I officially requested my records in April of 2022.

Shore Counseling and Consulting Clinic withheld my records from me for over two months until in June of 2022, Thomas Troast contacted me, insisting that I meet with him in person in order to access my records. 

Thomas Troast is a psychotherapist and also the CEO of Shore Counseling and Consulting Clinic. Although he holds a phd, he is not a psychiatrist. He was never my provider and I had never met him previous to June 16th, 2022. When I met with him, he refused to release my records to me. When I advocated for my legal rights, he told me that my tone was aggressive. He would not acknowledge that his behavior was abusive as well as illegal and I was unable to file a grievance with the clinic because of his involvement.

I did not receive my records until they came in the mail in July or August of 2022 and I did not receive all of the records that I had requested. 

Not only were my legal rights violated, but I also felt threatened and harassed when Thomas Troast took possession of my records, accessed my personal information, contacted me, pressured me to meet with him in order to receive my records, and continued to withhold my records from me. 

It is unlikely that the records I received depict a fair representation of reality - this cannot be treated as the truth or a fact, but it can reinforce the theory that Marla LaRock was not involved in commiting fraud and validates the necessity of further investigation.

The professional misconduct and misuse of his authority led me to believe that Thomas Troast might be protecting himself and his staff from consequences of committing healthcare fraud and abuse in addition to causing harm. As mentioned before, I have no reason to believe that my records were kept safe or confidential or in a way that was HIPPA compliant. 

Although psychological abuse is difficult to prove, especially because people with mental illness are less likely to be believed, healthcare fraud is not as difficult to prove. The reason that I have been investigating healthcare fraud and abuse on my own is to provide supplementary evidence that I expereinced psychological abuse.

At this time, I have contacted my insurance, United Healthcare. Although the representative was incredibly kind, the company did not seem as concerned as I was. The representative provided instructions on how to file an appeal but not able to help me after I requested an investigation.

I am unsuprised in our system that a mentally ill person who is a victim of healthcare fraud and abuse would not be taken seriously. I understand that United Healthcare does not value my life. When a vulnerable person in society is terrorized and taken advantage of, it is not considered terrorism.

Despite United Healthcare denying me the right to an official investigation, I was able to document the conversation and in the future, I will proceed with reporting Shore Counseling and Consulting Clinic to the IRS.

However, because it does not seem to be of concern and the United States Government has not dected fraud through there rigorous investigations and because of the possibility that United Healthcare is also complicit in committing fraud, I will collect my own evidence, construct my own theory, and create my own investigation before proceeding to report.