State Initiates False Claims Act, Breach of Contract Lawsuit against Norwich Behavioral Health Provider
The state has initiated a lawsuit alleging violations of the Connecticut False Claims Act and breach of contract by a licensed professional counselor from Norwich who is accused of billing the state's Medicaid program for services not provided, Attorney General George Jepsen and state Department of Social Services Commissioner Roderick L. Bremby said today. The lawsuit also alleges that the provider sought to conceal the scheme by failing to maintain required records or destroying records.
Susan Britt is a licensed professional counselor who resides and practices in Norwich, running her counseling practice – known as An Inner Peace – out of her home. Britt was formerly enrolled as a behavioral health provider in the Connecticut Medical Assistance Program (CMAP), which includes the state's Medicaid program.
The state alleges that from at least January 2013 through September 2016, Britt engaged in a scheme to falsely bill the CMAP for services that she never provided to her Medicaid patients. The state alleges that Britt would provide actual services to patients once or twice a week, but would then submit false claims and receive payment for three or four additional weekly counseling sessions with the same patients that she never actually conducted.
The state alleges that, in some instances, Britt would provide services to children, and then meet separately with their parents on one or two occasions, but would use the parents' Medicaid identification number to bill the CMAP for counseling sessions that she never provided to the parents. Some patients were not even in the state on some dates that Britt allegedly billed for providing counseling services.
The state further alleges that Britt informed state officials that she had destroyed all records for all of her patients in May or June 2016, including records documenting her patients' appointments and the services she purportedly provided to those patients, yet she continued to submit claims and receive payments for services she said she provided in June, July and August 2016. The state alleges that the purported destruction of records was in violation of requirements that patients be given notice before their records are destroyed, and that it represented a breach of Britt's CMAP provider agreement with the state, which requires certain records to be maintained for each patient enrolled in the CMAP.
"Fraud in our public healthcare programs simply will not be tolerated," said Attorney General Jepsen. "In this case, we allege that the defendant either never maintained or destroyed records in order to conceal a pervasive pattern of illegal billing. My office will continue to aggressively pursue those who seek to defraud the CMAP, and we're grateful for the continuing partnership with other enforcement agencies in investigating and pursuing these cases."
"Unfortunately, it's a fact of life that rooting out fraudulent activity and recovering wrongly-claimed funds has to be an essential part of overseeing public health coverage programs," said Commissioner Bremby. "In general, our health care providers help maintain program integrity standards, but there are outlier cases that require continual vigilance to detect and disrupt. We greatly appreciate the hard work and dedication of our state and federal partners with our DSS investigators."
During the relevant time period, Britt billed the state's CMAP for more than $530,000 in claims. The state's lawsuit seeks repayment of the false and undocumented claims, treble damages and other relief.
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), which has executed a warrant for Britt's arrest on related criminal charges, and the U.S. Department of Health and Human Services – Office of Inspector General's Office of Investigations (HHS-OIG-OI). Attorney General Jepsen and Commissioner Bremby thanked Connecticut's Chief State's Attorney Kevin Kane and his staff in the MFCU, and investigators with HHS-OIG-OI for their partnership in this case.
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 email@example.com; the MFCU at 860-258-5986 or by email at firstname.lastname@example.org; 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 email@example.com.
Legal Investigator Thomas Martin, Assistant Attorneys General Richard Porter and Michael Cole, chief of the Antitrust and Government Program Fraud Department, are assisting the Attorney General with this matter.
Please click here to view the state's complaint.
Office of the Attorney General:
Jaclyn M. Severance
Department of Social Services: