New Haven Behavioral Health Provider Agrees to Settlement, Suspension to Resolve False Claims Act Allegations
A former New Haven behavioral health clinician group and its owner have agreed to pay $100,000 and will be suspended from participating in Connecticut's Medicaid program for ten years for allegedly engaging in a systematic and long-term pattern of submitting false claims to the program, Attorney General William Tong and state Department of Social Services (DSS) Commissioner Roderick L. Bremby said today.
New Haven resident Lamaara Davis (Davis) is the owner and CEO of the Davis Group, LLC (Davis Group) which conducted business in New Haven under the name "Caring Family Solutions" and provided, among other services, temporary child care, afterschool programs, support groups for children and summer camps. The Davis Group enrolled in the Connecticut Medical Assistance Program (CMAP) – the state's Medicaid program – as a behavioral health clinician group in 2014.
A state investigation, initiated by a fraud referral from the DSS, found that from April 2014 through April 2017, the Davis Group submitted claims for psychotherapy services allegedly provided to CMAP patients by licensed behavioral health providers. The state alleged that the vast majority of those services were actually provided by unlicensed persons, in violation of CMAP regulations.
The state investigation developed evidence that, in some cases, psychotherapy services were never provided to patients at all and patients were not physically present on the dates that services were purported to have been provided. In other cases, the state found that the services provided were not psychotherapy services, but instead were services such as homework assistance, support groups or recreational activities that are not eligible for reimbursement through the CMAP.
"We take very seriously allegations of fraud and abuse in our taxpayer-funded healthcare programs," said Attorney General Tong. "The DSS relies on the accuracy and truthfulness of the information provided on claims for services when it reimburses healthcare providers. Services performed by unlicensed providers expose Medicaid patients to substandard care and undermine the integrity of our healthcare system. When providers engage in false and fraudulent schemes, they will be held accountable by my office."
"DSS investigators worked closely with the Attorney General's Office and other state and federal partners to disrupt these fraudulent practices," said Commissioner Bremby. "While the situation by no means represents behavioral health providers in general, strong anti-fraud measures are critical to safeguard the integrity of the taxpayer-funded Medicaid program."
As part of the settlement with the state, Davis and the Davis Group have agreed to pay $100,000 by forfeiting $12,409 in suspended payments, paying $25,000 immediately and repaying the balance of the settlement over time with interest. The settlement funds will be returned to the CMAP. Davis and the Davis Group have agreed to be suspended from CMAP participation for ten years. The Davis Group's "Caring Family Solutions" is no longer in operation.
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.
Assistant Attorney General Joshua Jackson, Forensic Fraud Examiner Thomas Martin, Legal Investigator Peter Harrington, 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 complaint and settlement document.
Jaclyn M. Severance