State Enters Joint Federal-State Settlement with Newtown
Psychiatrist Resolving False Claims Allegations
A Newtown psychiatrist has agreed to a $422,641.70 joint federal-state settlement and will enter into a compliance program to resolve allegations that he submitted false claims for payments to Connecticut's Medicaid program and to Medicare, Attorney General George Jepsen said today.
The Attorney General alleged that, while enrolled as a behavioral health and psychiatric services provider in the Connecticut Medical Assistance Program (CMAP), Dr. Naimentulla Syed knowingly submitted "upcoded" claims to the state Department of Social Services (DSS) for services provided to his Medicaid patients.
The practice of "upcoding" occurs when a provider knowingly uses a higher-paying code on the claim form for a CMAP recipient to reflect the use of a more expensive service, procedure or device than was actually used or was medically necessary.
The state alleged that, from July 2009 through December 2013, while operating a private practice, Dr. Syed submitted upcoded claims indicating that he provided Medicaid and Medicare patients with 45 minutes or more of face-to-face psychotherapy and a medical evaluation and management service when, in fact, he had provided 30 minutes or less of therapy and no evaluation and management service.
Under terms of the settlement, Dr. Syed did not admit liability but has agreed to a cash payment of $401,865.71 to the state and federal governments to resolve the False Claims Act allegations and will forfeit an additional $20,775.99 in funds the state withheld paying during the pendency of its investigation. The state's share of the settlement proceeds is $185,830.66. Additionally, Dr. Syed will implement a compliance program intended to prevent fraud and will be required to report to the Attorney General on his compliance annually for three years.
"Improper billing practices involving our Medicaid program will not be tolerated," said Attorney General Jepsen. "We are vigilant in working with our federal and state law enforcement partners to identify and prosecute fraudulent and abusive conduct, and we will continue to work to hold accountable those who seek to defraud and overcharge our taxpayer-funded healthcare programs."
Attorney General Jepsen thanked the DSS Office of Quality Assurance, the State of Connecticut Division of Criminal Justice Medicaid Fraud Control Unit, the U.S. Health and Human Services, Office of Inspector General – Office of Investigations and the U.S. Attorney's Office for the District of Connecticut for their assistance and coordination in this case.
DSS Commissioner Roderick L. Bremby said, "As administering agency for Medicaid in Connecticut, DSS joins our state and federal partners in a strong commitment to protect the integrity of the program. While this false claims case does not represent medical providers as a whole, it underscores the need for continual quality control and anti-fraud oversight. We thank Attorney General Jepsen and his staff, the state Division of Criminal Justice Medicaid Fraud Control Unit, the United States Attorney's Office, and the HHS Inspector General's Office for their outstanding work in coordination with DSS quality assurance investigators."
Today's action is part of a larger effort by the State of Connecticut's Interagency Fraud Task Force, which was created in July 2013 to wage a coordinated and proactive effort to investigate and prosecute healthcare fraud directed at state healthcare and human service programs. The Task Force includes a number of Connecticut agencies and works with federal counterparts in the U. S. Attorney's Office and the U.S. Health and Human Services, Office of Inspector General – Office of Investigations. For more information about the Task Force, please visit www.fightfraud.ct.gov.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Antitrust and Government Program Fraud Department at 860-808-5040 or by email at firstname.lastname@example.org; the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney at 860-258-5986 or by email at email@example.com; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud or by email at firstname.lastname@example.org.
Forensic Fraud Examiners David Boucher and Lawrence Marini, Paralegal Holly MacDonald and Assistant Attorneys General Gregory O'Connell and Michael Cole, chief of the Antitrust and Government Program Fraud Department, assisted the Attorney General with this matter.