STATE ANNOUNCES JOINT FEDERAL-STATE FALSE CLAIMS ACT SETTLEMENT WITH WATERBURY SOCIAL WORKER
(Hartford, CT) –Connecticut Attorney General William Tong and state Department of Social Services (DSS) Commissioner Roderick L. Bremby today announced a joint federal-state settlement with a school social worker who will pay $145,855 and will be suspended from participating in Connecticut's Medicaid program for three years to settle allegations that she submitted false claims for payment for psychotherapy services for children who were Medicaid recipients.
The state and the federal government allege that from January 2016 through September 2017, Patricia McAlinden, a licensed clinical social worker, enrolled as a behavioral health provider in the Connecticut Medical Assistance Program (CMAP), engaged in a scheme to submit false claims to the CMAP for psychotherapy sessions that were performed by an unlicensed individual. Although the services were performed by the unlicensed individual, the claims made it appear as if the behavioral health services were performed by McAlinden.
"As a provider enrolled in the CMAP, Patricia McAlinden had an obligation to provide claims for covered behavioral health services - - which means in this case, services rendered by a licensed clinical social worker to children who were Medicaid recipients. Instead, she allowed an untrained and unlicensed individual to provide the care and, as a result, defrauded the state of tens of thousands of dollars in Medicaid funds. The Office of the Attorney General will aggressively investigate and civilly prosecute those who seek to enrich themselves at the expense of this taxpayer funded healthcare program," said Attorney General William Tong.
“This False Claims Act settlement, like others resulting from anti-fraud investigations, should send a clear message that Medicaid demands the utmost integrity from all providers. While these cases are by no means typical of our enrolled providers, the outliers will continue to draw the close attention of state and federal agencies. We thank Attorney General Tong and his staff, the U.S. Attorney’s Office and our federal Health and Human Services partners for their work in cooperation with DSS Quality Assurance investigators,” said Commissioner Bremby.
The federal and state False Claims Act settlement was reached jointly with the U.S. Attorney's Office following an investigation by the U.S. Department of Health and Human Services (HHS) Office of the Inspector General/Office of Investigations and the Office of the Connecticut Attorney General. The investigation followed a referral from the Connecticut Department of Social Services' Office of Quality Assurance. The settlement will reimburse both the federal and state shares of the Medicaid program, with the state receiving 60 percent of the settlement funds.
McAlinden is currently employed by the Waterbury Public Schools as a social worker. The Department of Social Services is requiring that both the Waterbury Public Schools and the City of Waterbury provide written assurance that McAlinden will have no connection with any DSS administered program for the duration of her three-year suspension from the CMAP program.
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 Karla A. Turekian, Legal Investigator Timothy Edwards and retired Forensic Fraud Examiner Larry Marini, working under the direction of Assistant Attorney General Michael E. Cole, Chief of the Antitrust and Government Program Fraud Department, assisted the Attorney General in investigating and prosecuting this case.
Click here to view the Joint Settlement Agreement and the DSS Provider Suspension Agreement.