Connecticut Behavioral Health Provider Pays $273k to Settle Improper Billing Allegations(Hartford, CT) — Attorney General William Tong and Acting U.S. Attorney for the District of Connecticut Leonard C. Boyle today announced that Today’s Youth LLC and its owners, Maurice Stuckey and Joyce Anderson, have entered into a civil settlement agreement with the federal and state governments in which they will pay $273,000 to resolve allegations that they caused overpayments to be paid by the Connecticut Medicaid Program.
Today’s Youth is a healthcare organization that provides in-home family therapy and counseling in the greater Hartford area. The government’s allegations against Today’s Youth, Stuckey and Anderson arise out of improper billing for behavioral health services.
Today’s Youth is enrolled in the Connecticut Medical Assistance Program (“CMAP”), which includes Connecticut’s Medicaid program, as a “Behavioral Health Clinician Group.” The State of Connecticut Department of Social Services (“DSS”) contracted with Today’s Youth to provide behavioral health services to Medicaid beneficiaries. DSS does not reimburse a group practice such as Today’s Youth for behavioral health services provided by unlicensed individuals, even if the individuals are working toward licensure and supervised by a licensed individual. The DSS Provider Manual for Licensed Behavioral Health Clinicians in Independent Practice explicitly states, “The department shall not pay for…services provided by anyone other than the provider.”
The government alleges that despite clear guidance from the Medicaid program, Today’s Youth, Stuckey and Anderson routinely submitted claims to Medicaid for behavioral health services as if a licensed behavioral health clinician performed the services when, in fact, an unlicensed provider performed the services. As a result, Medicaid paid Today’s Youth for behavioral health services that the U.S. and Connecticut would not have paid for had they known unlicensed individuals provided the services.
“My office takes allegations of fraud and abuse in our taxpayer-funded healthcare programs very seriously,” Attorney General Tong said. “Services performed by unlicensed providers expose Medicaid patients to substandard care and undermine the integrity of our healthcare system. When providers fail to abide by their obligations in their provider contract with them, we stand ready with our state and federal partners to hold them accountable.”
“This enforcement action and settlement underscore the fact that vigorous oversight is needed to safeguard the integrity of our public health coverage programs,” DSS Commissioner and Acting Public Health Commissioner Dr. Deidre S. Gifford said. “I thank and commend our partners in the Attorney General’s Office, U.S. Attorney’s Office and Department of Health and Human Services for their outstanding work with DSS Quality Assurance investigators.”
To resolve its liability, Today’s Youth will pay $273,000 to the federal and state governments for conduct occurring between January 1, 2014 and September 1, 2019.
This matter was referred to the Office of the Connecticut U.S. Attorney and the Connecticut Attorney General by the DSS Office of Quality Assurance, and was investigated by Forensic Fraud Examiner Lisa Bailey, of the Connecticut Office of the Attorney General and the Office of the Inspector General for the Department of Health and Human Services. The case is being prosecuted by Assistant U.S. Attorney Anne F. Thidemann and by Assistant Attorney General Michael E. Cole of the Connecticut Office of the Attorney General.
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 report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.