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Monroe businessman faces fraud charge

Michael Clarence Johnston, 56, of Lauderhill, Florida, waived his right to a preliminary hearing, stemming from five felony charges related to fraud and theft at his former business.

Johnston is charged with submitting false claims to Medicaid, misrepresenting descriptions and dates of service in Medicaid claims, theft by deception, and two counts of dealing in proceeds of unlawful activities revolving around fraudulent practices at Vision Counseling Services in Brodheadsville.Vision was an outpatient mental health center that provided Monroe, Carbon and Pike county residents with mental health and substance abuse issues, owned and operated by Johnston.Officials said between May 29, 2012 and June 19, 2015, Johnston submitted numerous false claims of services to Community Care Behavioral Health and Medicaid, netting him over $100,000 in profit. The proceeds were funneled through money orders, money transfers and cash withdraws in order to avoid state and federal financial reporting requirements.Records indicate that Vision saw 91 unique Medicaid clients between 2011 and 2015.CCBH Fraud, Waste, and Abuse Clinical Auditor Fred Bresser had sent surveys to Vision patients to verify services, and that multiple disputes over the accuracy of the claims came up.Bresser said that CCBH attempted to perform several on-site audits of Vision, which Johnston claimed he could not attend due to travel and medical procedures for his wife.Bresser said that he found a "significant and suspicious spike" in Vision's 2015 bills to CCBH.Johnston stopped submitting claims to CCBH by the summer of 2015, and was concurrently taken off of the organization's provider network.Special Agent Tucker J. Beecher of the Pennsylvania Office of Attorney General, Bureau of Criminal Investigations, Medicaid Fraud Control Section, obtained Johnston's American Airlines flight records from 2012 to 2015, comparing dates with his claims.Beecher found that at least 14,375 units of service were billed by Johnston to Medicaid during times when he could not possibly have been at Vision.In February, several clients of Vision were interviewed, some saying that Beecher was the only counselor at the clinic, and would often run late or not show up to appointments.All of those interviewed disputed claims of service, including situations in which the client was not enrolled in a type of therapy that Medicaid had been billed for. After comparing the claims with the interviews, Beecher found at least 311 claims of service that never occurred.Upon exploring Citizens Bank account records for Vision, held in Johnston's name, Beecher found that Johnston would draw small sums of money from the account from multiple locations over the course of a day, seeking to avoid identification and logging under anti-money laundering practices.In May, Beecher obtained Western Union Financial Services money transfer records for Johnston, from the time when he was operating Vision. Beecher found over 259 transactions, with money transferred to different receivers in the U.S. and Jamaica, with Johnston altering his name to avoid tracking from Western Union. Records from Moneygram International show a similar protocol with 48 transactions.An interview with former Vision administrative employee Olive Hackett revealed that Hackett had help set up and handle electronic claims submissions for Vision, using the CCBH online portal. Hackett said that Johnston would often stay after hours to submit claims on his own. She said that she left Vision when Johnston showed that he was a "master manipulator," and CCBH had been questioning claims.Johnston has been held in Monroe County Correctional Facility since Sept. 22, with a bail of $250,000, which he has currently been unable to post.