Attorney General Tong Announces $384K Settlement With Community Mental Health Partners Over Medicaid Overcharge
(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 with the federal and state governments in which it will pay $384,322 to resolve allegations that it overcharged 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 home residents that it did not fully document. Working together with our federal law enforcement partners, today’s agreement ensures that public health dollars are used appropriately to support the needs of patients.” Attorney General Tong said.
“This civil settlement underscores the fact that health care providers must adhere to the highest standards of service delivery and billing in our publicly funded Medicaid program. While the majority of enrolled providers fulfill these responsibilities, it is also clear that maintaining the integrity of the program must remain a high priority. I join Attorney General Tong in thanking our state and federal partners and, in this case, the whistleblower who filed the original complaint.” said commissioner candidate Andrea Barton Reeves of the Department of Human Services, Connecticut’s Medicaid administering agency.
CMHA is a behavioral health provider headquartered in New Britain and has 10 locations in northwestern and central Connecticut. At one of its locations, Harvest House in New Britain, CMHA operates 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 resulting from serious and persistent mental illness achieve maximum functioning in self-care and independent living. To receive monthly MRO payments, a behavioral health provider, such as a CMHA, must provide clients with at least 40 hours of MRO services per month and document those services in accordance with Medicaid requirements.
The government alleged that CMHA submitted claims for MRO services to Connecticut Medicaid for certain clients for certain months at Harvest House and paid them the monthly fee for those services, but failed to document at least 40 hours of covered MRO services per month for the clients at a question.
To resolve the governments’ common law claims, CMHA agreed to pay $384,322, covering the period from January 2015 to December 2019.
CMHA’s investigation was initiated by the filing of a complaint under the whistleblower provisions of federal and state false claims laws. The relative (whistleblower) will receive 15 percent of the $57,648 settlement.
The case related to this settlement is entitled United States v. State of Connecticut ex rel. Lugli v. Community Mental Health Affiliates, Inc. (Docket No. 20-cv-1483).
Assistant Attorney General Rick Porter and fraud forensic expert Tom Martin, under the direction of Gregory K. O’Connell, Chief of the Government Program Fraud Division, assisted the Attorney General in this matter.
Anyone with knowledge of suspected fraud or abuse in the public health care system is asked to contact the Fraud Unit of the Attorney General’s Government Program at 860-808-5040 or by email at [email protected]; or the Department of Human Services Fraud Reporting Hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud or by email at [email protected]
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