Attorney General Tong Announces $739,759 Settlement with Manchester Pediatric Associates Over False Medicaid Billing
(Hartford, CT) — Attorney General William Tong today announced a $739,759.52 Connecticut False Claims Act settlement with Manchester Pediatric Associates, LLC (MPA), and its owner, Dr. Swathanthra Melekote to resolve allegations that MPA submitted false and fraudulent claims between January 2015 and May 2021 that resulted in overbilling the Connecticut Medicaid program.
“Over the course of more than five years, Manchester Pediatric Associates and its owner Dr. Melekote, knowingly and systematically submitted hundreds of thousands of dollars of false claims to the Medicaid program for services he did not perform to maximize his own profit. These false claims and fraudulent double billing practices misused Connecticut Medicaid resources intended for the medical care of our state’s most vulnerable residents,” Attorney General Tong said. “The Office of the Attorney General takes seriously our responsibility to safeguard our public healthcare programs and is prepared to take strong action against anyone who violates that public trust.”
“These inexcusable violations under the False Claims Act have resulted in a major settlement amount being returned the Medicaid program,” Department of Social Services Commissioner Deidre S. Gifford said. “While such violations do not represent Medicaid providers as a whole, the case underscores the continuing need for strong enforcement of public integrity standards. I thank the Attorney General and his staff, our DSS anti-fraud investigators, and all partners who work to safeguard taxpayer investments in our health coverage programs.”
Manchester Pediatric Associates serves approximately 5,700 pediatric Medicaid patients in South Windsor, Torrington, and Tolland. Following a whistleblower complaint, the Office of the Attorney General worked with the Department of Social Services Special Investigations Unit to conduct an investigation into Melekote’s questionable billing practices.
The investigation — which included a review of claims data for MPA Medicaid patients’ medical records, as well as extensive interviews with current and former MPA employees — found that Melekote violated the Connecticut False Claims Act by knowingly billing Medicaid twice for maternal depression screenings and vaccine administration and by “up-coding” to bill for medical services as if a physician had provided the services, instead of a physician assistant or nurse practitioner, which would have been reimbursed at a lower rate. Melekote also billed Medicaid for maternal depression screens after a patient was one year old, and without adequate documentation that the service was provided in the patient’s medical records.
The investigation also found that Melekote directed staff to attach numerical “modifiers” to the codes entered on the electronic claim for payment for a service that MPA submitted to DSS’s claims processor. This was how MPA was able to “double bill” for a single maternal depression screen or single vaccine administration. MPA employees were told to bill from a “billing guide” created by Melekote without regard to whether the billed services were in the patient’s medical record, and without regard to whether a mid-level practitioner rather than a physician provided the service.
The total settlement amount is $739, 759.52 and will be paid no later than Dec. 30, 2021.
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; 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 email@example.com.
Assistant Attorney General Karla Turekian, Forensic Fraud Examiner Lisa Bailey, Forensic Fraud Examiner Tom Martin and Paralegal Orlean Woodham, and Antitrust and Government Program Fraud Section Chief Jeremy Pearlman assisted the Attorney General with this matter.