A Connecticut healthcare organization and its chief executive officer have reached an $883,859 settlement with the state of Connecticut and the federal government to resolve allegations that the company submitted improper claims for payment to Connecticut's Medicaid program, Attorney General George Jepsen and state Department of Social Services (DSS) Commissioner Roderick L. Bremby said today. 

The APT Foundation, Inc. (APT), is a behavioral health and substance use disorder services provider with clinics in New Haven, North Haven, and Bridgeport. APT provides methadone maintenance and detoxification services.  Ms. Lynn Madden is APT's chief executive officer.  APT is enrolled as a provider in the Connecticut Medical Assistance Program (CMAP), which includes the Connecticut Medicaid Program. The DSS administers the CMAP.

The CMAP reimburses methadone clinics, including APT, utilizing a weekly rate payment for each CMAP patient who is provided methadone treatment. In October 2013, the DSS implemented a regulation stating that the weekly rate payment includes reimbursement for any and all medically necessary services provided to a patient, including the initial patient evaluation and physical examination, on-site drug abuse testing and monitoring, and counseling services. In September 2014, the DSS issued a bulletin to all methadone clinics, including APT, reminding them that the weekly rate payment included reimbursement for on-site drug abuse testing and monitoring. In February 2015, the DSS published on its official State website specific information directed to methadone clinics that notified them that if a DSS audit found the CMAP paid another laboratory provider for drug testing within a week of the date a methadone clinic was paid for methadone treatment, the CMAP would reduce the methadone clinic's payment for the methadone treatment service by the cost of the laboratory service. The DSS eventually audited APT and found that APT was in violation of the weekly payment rate rule and warned the provider that continued non-compliance with the weekly rate payment rule would result in financial disallowances in future audits. 
The State of Connecticut and the United States contend that APT and Madden nevertheless continued, from January 2016 until November 2016, to refer drug testing services for APT patients to an independent laboratory, while at the same time, APT and Madden submitted claims for payment to DSS for the weekly rate payment, which includes drug testing, for the same APT patients. As a result, DSS paid for the claims twice, once to the independent laboratory and once to APT. 
"With limited resources available to help those who are truly in need in the opioid epidemic our state and nation currently faces, it is critical that we get the most from each tax dollar spent on treatment.  Methadone clinics enrolled as providers in the CMAP have a responsibility to comply with all laws and regulations when they submit claims for payment," Attorney General Jepsen said. "My office and our law enforcement partners will continue to diligently pursue those who have received improper reimbursements from the Medicaid program. I credit APT and Ms. Madden for stepping up to rectify their improper claims process while also cooperating with this investigation." 
Attorney General Jepsen thanked the U. S. Department of Health and Human Services, Office of the Inspector General and the Office of the United States Attorney for their coordination in this case. Jepsen also thanked the DSS Office of Quality Assurance for the considerable assistance they provided. 

"This settlement of nearly $885,000 from the APT Foundation to the state and federal governments should raise awareness among all enrolled medical providers about the absolute need for careful adherence to billing and claiming requirements," DSS Commissioner Roderick L. Bremby said. "I join Attorney General Jepsen in commending his team, our federal partners and DSS staff for their outstanding work in the investigation and resolution of this case."

To resolve the investigation, APT will pay a total settlement amount of $883,859. In accord with the CMAP cost sharing between the United States and Connecticut, the state will receive 50% of the settlement at a total of $441,929.50. The state's share of funds will be returned to the CMAP.

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.

Assistant Attorney General Gregory O'Connell and Assistant Attorney General Michael Cole, chief of the Antitrust and Government Program Fraud Department, assisted the Attorney General with this matter.

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 ag.fraud@ct.gov; the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney at 860-258-5986 or by email at conndcj@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.

Please click here to view the settlement document.