A progressive behavioral healthcare company with locations in Big Stone Gap and Culpeper, Virginia, has been ordered to pay $4,611,375 to resolve allegations it billed Virginia Medicaid for services not provided.
Health Connect America (HCA), headquartered in Franklin, Tenn., also further agreed to be subject to a period of five years of increased compliance and oversight. Any failure to comply with its obligations during this time could result in criminal prosecution of the company. Contempt of court proceedings could also result in monetary sanctions and injunctive relief.
“Ensuring that healthcare providers accurately bill programs such as Medicaid and Medicare are one of the cornerstone functions of law enforcement,” United States Attorney Christopher R. Kavanaugh said last week. “When providers fail in that mission, we must hold them accountable. I am grateful to all those who worked on this matter and brought it to a just conclusion.”
In three separate behavioral health services available for children who qualify, HCA billed Medicaid improperly. Therapeutic Day Treatment is a school-based program designed to assist children with various mental health diagnoses who need support at school during the day. HCA billed Virginia Medicaid for services provided to students who did not attend school because school was not open for a holiday or for weather closures.
“Health Connect America tried to charge Virginia Medicaid for child behavioral health services they never performed. I’m proud of the collaboration between my office and our federal partners in reaching an agreement and bringing justice,” said Virginia Attorney General Jason Miyares.
Intensive In-Home Services provides a home-based program for children who have various mental health diagnoses and are at risk of being removed from their home. HCA billed Virginia Medicaid for intensive in-home services provided by an employee who was sexually abusing a juvenile patient in Orange County, Va. The employee was prosecuted and is serving a 10-year sentence.
“Health care providers have a responsibility to submit accurate and honest claims to federal health care programs to ensure that these resources are available for eligible patients,” Maureen Dixon, Special Agent in Charge at the Department of Health and Human Services, Office of Inspector General (HHS-OIG), said. “HHS-OIG is committed to safeguarding valuable taxpayer dollars and protecting the integrity of the Medicaid program.”
In the third instance of misbilling, HCA billed Behavioral Health Services, a specialized mental health service for children, including children with autism, for services provided by individuals who were not properly trained or credentialed.
As part of the agreement, HCA has agreed to increased compliance and audit requirements, unannounced audits and enhanced reporting requirements if and when incidents of theft, fraud, abuse or neglect are detected.
Resolutions are obtained in a coordinated effort by the United States Attorney’s Office for the Western District of Virginia, the Virginia Attorney General’s Office Medicaid Fraud Control Unit, and the United States Department of Health and Human Services-Office of the Inspector General.