Connecticut Announces $4.9 Million State/Federal False Claims Settlement with Middletown Doctor Couple
First CT False Claims Act Settlement to Date Involving State Health Plan
(Hartford, CT) –Attorney General William Tong, U.S. Attorney John H. Durham, Comptroller Kevin Lembo and Connecticut Department of Social Services Commissioner Deidre S. Gifford announced today that Connecticut has reached a $4.9 million civil False Claims Act settlement with Middletown couple Crispin and Antonieta Abarientos regarding a long-term fraudulent medical billing scheme involving costly infusions. This is the first False Claims settlement to date regarding the Connecticut State Health Plan.
Crispin Abarientos, a rheumatologist, operated Middlesex Rheumatology in Middletown, a practice that he co-owned with his wife, Antonieta Abarientos, a primary care physician. Antonieta Abarientos was also employed by Connecticut Valley Hospital.
A joint investigation by the Office of the Attorney General; the United States Attorney's Office, District of Connecticut; the United States Department of Health and Human Services, Office of the Inspector General, Office of Investigations; the Federal Bureau of Investigations and the Medicaid Fraud Control Unit in the Office of the Chief State's Attorney --initiated by a fraud referral from the DSS Office of Quality Assurance's Special Investigations Unit--found that between September 2013 and January 2018, the couple engaged in a fraudulent billing scheme involving Remicade, an injectable prescription drug used to treat rheumatoid arthritis, Crohn’s disease and other conditions. The drug is administered via infusion. Remicade is a very expensive drug and can cost between $4,000 – to $10,000 for each infusion.
The scheme took advantage of two different Remicade reimbursement systems used by Medicaid, and Medicare and the State Health Plan. When a physician writes a Remicaid prescription, Medicaid covers the cost of the drug up front, with no out of pocket cost to the practice. The drug is then shipped to the practice for later infusion into the patient. Medicaid pays the specialty pharmacy for the Remicade and separately reimburses the physician, in this case Middlesex Rheumatology, for administering the drug. Conversely, for patients covered by Medicare or the State Health Plan, the reimbursement paid to Middlesex Rheumatology includes the cost of the Remicade, which is considered an expense for the practice because under this scenario the practice is required to independently purchase the Remicade from a drug wholesaler. In addition, the practice is also reimbursed for administering the drug.
Exploiting these different reimbursement systems, Crispin Abarientos first submitted claims for Remicade on behalf of his Medicaid patients. Medicaid then paid the specialty pharmacy for the medication and paid the practice for administering the infusion. In many instances, Crispin Abarientos did not administer the Remicade to his Medicaid patients but instead used the drug to infuse his patients covered by Medicare or the Connecticut State Health Plan. Under this scheme Crispin Abarientos obtained undue reimbursement for the Remicade, which he had procured at no cost through the Medicaid Program. Through this scheme, Middlesex Rheumatology was reimbursed $894,789 for certain Medicaid patients that never received the drug, and fraudulently used the supply of Remicade to falsely bill Medicare and the State Health Plan approximately $2.2 million and $610,000 respectively.
“Crispin and Antonieta Abarientos ran what amounts to a long-term double-billing scheme that defrauded Connecticut taxpayers of millions of dollars. This major False Claims Act settlement holds the couple accountable for the damages they caused the state. Working in close collaboration with our state and federal partners, my office will aggressively protect our taxpayer-funded healthcare programs,” said Attorney General Tong.
“This case is a special illustration of how fraud and corruption can betray not only the medical profession but publicly-funded health services intended for our lowest-income citizens. While not reflecting the integrity of our health programs in general, this sad situation clearly shows the need for effective investigation and enforcement of provider fraud. I join Attorney General Tong in commending the skilled and dedicated personnel across all state and federal oversight agencies,” said Commissioner Gifford, whose agency administers Medicaid.
“These physicians were trusted by patients to provide good medical care – but instead used their patients to compromise the state health plan and Medicaid through reimbursement schemes,” Comptroller Lembo said. “This diversion of scarce public resources intended for essential health care will not be tolerated. I commend Attorney General William Tong and U.S. Attorney John H. Durham – and our cross-agency collaborative team – for their work to investigate and pursue this case. This settlement sends a message of zero tolerance for any attempt to undermine the state plan.”
Crispin Abarientos is currently serving a 37-month prison sentence after pleading guilty on October 30, 2019 in federal court to one count of health care fraud for his role in the schemes. He began serving his sentence in January, to be followed by two years of supervised release. He has also paid the Medicaid Program $894,789 in criminal restitution. As a result of the criminal conviction, Crispin Abarientos will be barred from participating in federal healthcare programs for five years. Antonieta Abarientos was not charged criminally. She cooperated in the investigation.
Attorney General Tong thanked the HHS Office of the Inspector General/Office of Investigations, the Office of the United States Attorney, the Federal Bureau of Investigation and the Medicaid Fraud Control Unit for their coordination in this case. Attorney General Tong also thanked the DSS Office of Quality Assurance and the Healthcare Policy & Benefit Services Division of the Office of the State Comptroller for the considerable assistance they provided.
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 Investigator Peter Harrington and Assistant Attorney General Michael E. Cole, Chief of the Antitrust and Government Program Fraud Department, assisted the Attorney General with this matter.