AG TONG, DSS COMMISSIONER GIFFORD, COMPTROLLER LEMBO ANNOUNCE FALSE CLAIMS ACT LAWSUIT AGAINST THERAPY UNLIMITED FOR ALLEGEDLY SUBMITTING FALSE CLAIMS TO CONNECTICUT'S MEDICAID AND STATE HEALTHCARE PROGRAMS
Attorney General William Tong, Connecticut Department of Social Services Commissioner Deidre S. Gifford, and State Comptroller Kevin Lembo, today announced a lawsuit against Therapy Unlimited, LLC and its owner, Catherine Risigo Wickline, for allegedly engaging in pervasive and illegal schemes to submit false claims to Connecticut's Medicaid program and the state employee/retiree health plan for millions of dollars of reimbursements that they were not entitled to receive.
The lawsuit, to be filed in Hartford Superior Court, alleges that Therapy Unlimited, LLC and Wickline violated the Connecticut False Claims Act by knowingly and systematically submitting thousands of false claims for reimbursement for occupational therapy (OT) and physical therapy (PT) for more treatment time than the therapists actually provided to minor patients who receive health care through Connecticut's Medicaid program or the state employee health plan.
In addition, the lawsuit alleges that Therapy Unlimited, LLC, and Wickline violated the Connecticut False Claims Act by knowingly submitting more than a thousand false claims for reimbursement for OT and PT delivered to minor patients by unlicensed staff. The lawsuit also alleges that Therapy Unlimited, LLC, breached its provider agreement with the Department of Social Services by billing the Department for services delivered by providers who were not enrolled in Connecticut's Medicaid program as required by the provider contract and Connecticut regulations.
"Therapy Unlimited, LLC and its owner Catherine Risigo Wickline allegedly engaged in an illegal scheme to manipulate the system to improperly enrich herself at the taxpayers’ expense by submitting false claims to Connecticut's Medicaid program and its state employee health plan. Diverting taxpayer funds from the necessary services they are intended for increases the costs borne by federal and state-funded healthcare programs. I want to thank our partners at the Department of Social Services and the Office of the Comptroller for their assistance in this investigation. Together we will do everything we can to hold these bad actors accountable," said Attorney General Tong.
“The Medicaid program is responsible for providing care and services to many of Connecticut’s most vulnerable residents of all ages. We are grateful to the vast majority of providers who partner with us to deliver these vital services, and who do so in accordance with their enrollment agreements and the laws and regulations around Medicaid. However, in cases where credible evidence points to alleged violation of those laws and agreements, we must take action in order to protect the integrity of the program, and to ensure the highest quality care to those we serve. I thank Attorney General Tong and his highly professional staff and our dedicated team of quality assurance investigators at DSS. We will continue to work with our providers to make efficient and high quality care available to participants in our program,” said DSS Commissioner Gifford.
"Today’s legal actions should send a loud message to bad actors seeking to defraud the state health plan and Connecticut patients: you will be caught and there will be consequences. I’m grateful for Attorney General Tong’s commitment to pursuing enforcement litigation and his office’s diligence in this matter,” said Comptroller Lembo.
Since January 2014, Therapy Unlimited, LLC allegedly billed thousands of claims to the Connecticut Medical Assistance Program, which includes the Connecticut Medicaid Program, for two and a half hours of OT and PT services when patient sessions lasted, on average, less than 45 minutes. Therapy Unlimited, LLC also allegedly billed the state employee health plan for three hours or more of OT/PT services when patient sessions lasted approximately one hour.
Therapy Unlimited, LLC also allegedly used unlicensed staff, including a former OT student and a personal trainer who conducted fitness groups, to provide OT and PT services to children, and then billed Connecticut's Medicaid program for the services delivered by its unlicensed staff.
The lawsuit seeks damages on behalf of the healthcare plans, civil penalties, costs of investigation and other appropriate relief.
Legal Investigator Peter Harrington, and Assistant Attorneys General Richard M. Porter and Michael Cole, Chief of the Antitrust and Government Program Fraud Department assisted the Attorney General with this matter.
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 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.