STATE REACHES FALSE CLAIMS ACT SETTLEMENT WITH WEST HAVEN BEHAVIORAL ANALYST REGARDING IMPROPER BILLING FOR AUTISM SERVICES
A West Haven behavioral analyst has agreed to pay $20,000 and will be suspended from participating in Connecticut's Medicaid program for three years for allegedly submitting false claims for Autism Spectrum Disorder (ASD) services, Attorney General William Tong and state Department of Social Services (DSS) Commissioner Roderick L. Bremby announced today. Settlement funds will be returned to the Connecticut Medical Assistance Program (CMAP).
The state alleged that Harry Voulgarakis and his related entities HMV Psychological Services, Shoreline Social Learning, and Shoreline Center for Social Learning violated the Connecticut False Claims Act by billing for ASD services that were not rendered during the time period beginning on June 10, 2015 through at least May 2018.
"Harry Voulgarakis violated the public trust by defrauding the state of thousands of dollars in Medicaid funds. But more importantly, he deprived children with Autism Spectrum Disorder of expert observation and direction services needed to advance their care and treatment. This settlement sends a clear message that the Office of the Attorney General will aggressively defend our social safety net against those who compromise patient care for personal gain," said Attorney General William Tong.
“We thank the Attorney General’s Office for working closely with DSS anti-fraud investigators and our other state and federal partners to root out this type of inexcusable activity,” said Commissioner Bremby. “Safeguarding the integrity of the Medicaid program is of utmost priority, on behalf of our patients throughout Connecticut and the taxpaying public in general.”
During the time in question, Voulgarakis was a Board Certified Behavioral Analyst (BCBA) enrolled as a provider in the CMAP delivering ASD evaluation and treatment to CMAP recipients. Such ASD treatment services include a comprehensive diagnostic evaluation, behavior assessment, and development of a plan of care and medically necessary interventions. ASD services are usually provided in the recipient's home by a technician under the direct observation of a qualified BCBA. The state's investigation found that Voulgarakis submitted claims for the direct observation and direction of the technician, yet was rarely present during the times when the technicians were providing ASD treatment services. Most of Voulgarakis's clients were children under the age of 18.
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 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 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 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.
Legal Investigators Peter Harrington, Timothy Edwards and former Forensic Fraud Examiner Lawrence Marini, and Assistant Attorney General Michael E. Cole, Chief of the Antitrust and Government Program Fraud Department assisted the Attorney General in this matter.
Click here to view the complaint and settlement agreement.