Press Releases
02/02/2023
Attorney General Tong Announces $384K Settlement with Community Mental Health Affiliates Over Medicaid Overbilling
(Hartford, CT) – Attorney General William Tong and United States Attorney Vanessa Roberts Avery today announced that Community Mental Health Affiliates, Inc. (“CMHA”), has entered into a civil settlement agreement with the federal and state governments in which it will pay $384,322 to resolve allegations it overbilled the Connecticut Medicaid program for certain behavioral health services.“This settlement resolves allegations that CMHA billed the Connecticut Medicaid program for behavioral health services for disabled group home residents that it did not fully document. Acting in conjunction with our federal law enforcement partners, today’s settlement ensures public healthcare dollars are used appropriately to support patients’ needs,” said Attorney General Tong.
“This civil settlement underscores the fact that health care providers must adhere to the highest standards of service provision and billing in our publicly-funded Medicaid program. While the great majority of enrolled providers fulfill these responsibilities, it is also clear that safeguarding the program’s integrity must remain a high priority. I join Attorney General Tong in thanking our state and federal partners and, in this case, a whistleblower who filed the original complaint,” said Commissioner-designate Andrea Barton Reeves of the Department of Social Services, administering agency for Medicaid in Connecticut.
CMHA is a behavioral health provider with a headquarters in New Britain and has 10 locations in northwestern and central Connecticut. At one of its locations, Harvest House in New Britain, CMHA runs a group home for clients with serious and persistent mental illness.
CMHA provides Medicaid Rehabilitation Option (MRO) services to its clients residing at Harvest House. MRO services are designed to help clients who have functional disabilities secondary to serious and persistent mental illness achieve maximum functioning in self-care and independent living. In order to receive monthly MRO payments, a behavioral health provider, such as CMHA, must furnish clients with at least 40 hours of MRO services per month and document such services in accordance with Medicaid requirements.
The government alleges that CMHA submitted claims for MRO services to Connecticut Medicaid for certain clients for certain months at Harvest House and were paid the monthly fee for those services, but failed to document at least 40 hours of covered MRO services per month for the clients in question.
To resolve the governments’ common law claims, CMHA agreed to pay $384,322, which covers the time-period from January 2015 through December 2019.
The investigation of CMHA was initiated through the filing of a complaint under the whistleblower provisions of the federal and state False Claims Acts. The relator (whistleblower) will receive 15 percent of the settlement, in the amount of $57,648.
The case related to this settlement is captioned United States and State of Connecticut ex rel. Lugli v. Community Mental Health Affiliates, Inc. (Docket No. 20-cv-1483).
Assistant Attorney General Rick Porter and Forensic Fraud Examiner Tom Martin, under the supervision of Gregory K. O'Connell, Chief of the Government Program Fraud Section, assisted the Attorney General in this matter.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Government Program Fraud Section at 860-808-5040 or by email at ag.fraud@ct.gov; 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 providerfraud.dss@ct.gov.
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Media Contact:
Elizabeth Benton
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