Conn. Enters Joint State-Federal False Claims Act Settlement with Waterford Behavioral Health Provider
The state and federal governments have reached a joint settlement resolving allegations that a Waterford psychologist submitted false claims for behavioral health services she never provided to her Connecticut Medicaid patients, Attorney General George Jepsen and Connecticut Department of Social Services (DSS) Commissioner Roderick L. Bremby said today.
Dr. Arlene Werner, a licensed psychologist and owner and sole practitioner of a private psychology practice, will pay $126,760.09 and has been suspended from participation in the Connecticut Medical Assistance Program (CMAP) – which includes the state's Medicaid program – for a period of two years.
The state and federal governments alleged that, from January 2011 to July 2016, Dr. Werner submitted false claims to the CMAP for psychotherapy services that were not provided to her CMAP patients.
In addition to submitting claims for services not rendered, the government also alleged that Dr. Werner submitted false claims to the DSS for family psychotherapy services for multiple members of certain families on the same date of service – a service that has the highest reimbursement rate for any psychotherapy session paid by the CMAP – when in fact she should have submitted claims for individual psychotherapy services, which were the services she actually provided. Individual psychotherapy is reimbursed at a lower rate than family psychotherapy. This is a practice known as "upcoding." Upcoding occurs when a provider knowingly submits claims for a higher-reimbursed procedure code on the claim form that reflects the use of a more expensive service, procedure or device than was actually used or was medically necessary.
"My office will continue to vigorously pursue those who seek to defraud our public healthcare programs," said Attorney General Jepsen. "I am grateful to our federal law enforcement partners and to Connecticut's U.S. Attorney for their continued coordination in investigating and prosecuting False Claims Act violations."
"This case is another example of the outstanding work by state and federal partners involved in anti-fraud oversight of the Medicaid program," said Commissioner Bremby. "I join Attorney General Jepsen in thanking the dedicated professionals who took part in this investigation and resulting settlement to recoup public funding."
Of the settlement funds, $76,056.05 represents the state's share and will be returned to the CMAP; the remainder of the settlement funds will be remitted to the federal government.
This investigation was initiated by a fraud referral from the DSS Office of Quality Assurance’s Special Investigations Unit and was conducted jointly with the state's Medicaid Fraud Control Unit (MFCU) and U.S. Health and Human Services, Office of Inspector General – Office of Investigations (HHS-OIG-OI).
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 HHS-OIG-OI. For more information, 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 MFCU 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 to firstname.lastname@example.org.
Assistant Attorney General Antonia Conti, Legal Investigator Larry Marini and Assistant Attorney General Michael Cole, chief of the Antitrust and Government Program Fraud Department, assisted the Attorney General with this matter.
Please click here to view the settlement document.
Office of the Attorney General:
Jaclyn M. Severance
Department of Social Services: