Conn. Reaches Joint State-Federal False Claims Act Settlement with New Haven, Bridgeport Behavioral Health Provider
A behavioral health and substance abuse treatment provider with locations in New Haven and Bridgeport and its owners have agreed to pay $1,378,533 to resolve a joint state-federal investigation into allegations that they submitted false claims for payment to Connecticut's Medicaid program, Attorney General George Jepsen and state Department of Social Services (DSS) Commissioner Roderick L. Bremby said today.
New Era Rehabilitation Center and its co-founders and owners – Dr. Ebenezer Kolade and Dr. Christina Kolade – are enrolled as providers in the Connecticut Medical Assistance Program (CMAP), which includes the state's Medicaid program. As part of their practice, they provide methadone treatment services for patients dealing with opioid addiction. Most of their patients are CMAP beneficiaries.
During the relevant time period, CMAP reimbursed methadone clinics by paying a weekly bundled rate that included all of the services associated with methadone maintenance, including the patient's doses of methadone; the initial intake evaluation; a physical examination; periodic drug testing; and individual, group and family drug counseling. Drug counseling is not the same as outpatient psychotherapy, which is a more intensive service that must be provided by a physician or other qualified healthcare professional.
The state and federal governments alleged that, from October 2009 to November 2013, New Era and the Kolades engaged in a pattern and practice of billing CMAP weekly for the methadone bundled service rate and then also submitting a separate claim to the CMAP for virtually every drug counseling session provided to clients by using a billing code for outpatient psychotherapy. The state and federal governments further alleged that those psychotherapy sessions were actually the drug counseling sessions already included and reimbursed through the bundled rate.,
"Providers enrolled in Connecticut's Medicaid program are required to play by the rules," said Attorney General Jepsen. "In this case, we alleged that the providers billed for psychotherapy services that were not actually provided in addition to billing, in effect, twice for the same services. This conduct diverted taxpayer dollars earmarked to help fight the opioid epidemic that has plagued our state. Thus, recovering these funds is among my highest priorities. We're grateful to our law enforcement partners for their continued partnership as we seek to hold accountable those who take advantage of our taxpayer-funded healthcare programs."
"Responsible compliance with federal and state claiming rules is something that every provider must observe when enrolled in public health coverage programs," said Commissioner Bremby. "The alternative is opening the system to wrongful billing and other forms of waste and abuse, whether deliberate or unintentional. I am proud of our DSS investigators for initiating this case, and highly appreciative of the Attorney General's Office and our other partners at the state and federal levels."
Of the $1,378,533 in settlement funds, the state's share of $881,945 will be returned to the CMAP.
Attorney General Jepsen and Commissioner Bremby thanked Connecticut U.S. Attorney John H. Durham and his staff as well as investigators with the U.S. Health and Human Services, Office of Inspector General – Office of Investigations for their partnership in investigating this matter. This investigation was initiated by a fraud referral from the DSS Office of Quality Assurance’s Special Investigations Unit.
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, 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 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.
Forensic Fraud Investigator Lawrence Marini and Assistant Attorneys General Antonia Conti and Michael Cole, chief of the Antitrust and Government Program Fraud Department, assisted the Attorney General with this matter.
Office of the Attorney General:
Jaclyn M. Severance
Department of Social Services: