BEHAVIORAL HEALTH AND SUBSTANCE ABUSE TREATMENT
DA TE
ENTITY
FCA ALLEGATIONS
AMOUNT
Community-based behavioral health provider agreed to two consent judgments totaling over $15 million to resolve FCA and CSA allegations. The provider agreed to pay more than $13.758 million to resolve FCA allegations that it billed Medicare for upcoded mental health services and other ineligible claims. The provider also agreed to pay more than $1.62 million to resolve CSA allegations that it did not keep proper records of its use of controlled substances and transferred controlled substances between locations without proper documentation. 78 Therapy clinic operator and its parent company agreed to pay more than $390,000 to resolve FCA allegations that two of its facilities licensed to provide Community Support Programs submitted claims to Wisconsin Medicaid for services provided by unqualified individuals, group services that were billed as if they were individual services, and non-face-to-face services that were not eligible for payment. 79 Mental health services provider and its CEO agreed to pay $700,000 to resolve state and federal FCA allegations that they billed Virginia Medicaid for: (1) services that they did not provide; (2) services that were provided by unlicensed individuals; and (3) services provided without the requisite initial assessment completed by a licensed counselor. 80 Psychiatric hospital and its owner agreed to pay $425,000 to resolve FCA allegations that they billed Medicare and Ohio Medicaid for diagnostic testing that was: (1) performed during patients’ inpatient stays at the hospital and thus ineligible for separate reimbursement; (2) not used in the management of patients’ conditions; and (3) not medically necessary. 81
Connections Community Support Programs, Inc.
8/26/2021
$15.379 million
Bell Therapy, Inc.; Phoenix Care Systems, Inc.
9/3/2021
$390,080
NDUTIME Youth & Family Services, Inc.; Teshana Gipson
9/16/2021
$700,000
Access Hospital Dayton, LLC; Dr. John Johnson
$425,000
11/3/2021
78 https://www.justice.gov/usao-de/pr/connections-community-support-programs-agrees-judgments-over-15-million-resolve-health. 79 https://www.justice.gov/usao-edwi/pr/milwaukee-area-community-support-program-facilities-agree-pay-390080-resolve-false. 80 https://www.justice.gov/usao-edva/pr/ndutime-youth-family-services-and-its-ceo-settle-false-claims-act-allegations-relating. 81 https://www.justice.gov/usao-sdoh/pr/dayton-psychiatric-hospital-and-owner-agree-pay-425000-resolve-claims-unnecessary.
NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 61
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