by Ben Vernia | September 30th, 2014
On September 24, the U.S. Attorney’s office for the Western District of Michigan announced that it had settled various false claims allegations – including services billed by a provider with a lapsed license, services failing to satisfy supervision and documentation requirements, and upcoded claims. In the unusual agreement, DOJ will receive no settlement payments, and accepted only compliance program changes. According to the U.S. Attorney’s press release:
Catholic Charities West Michigan, a nonprofit organization based in Grand Rapids, has entered into an agreement with the U.S. Attorney’s Office for the Western District of Michigan that requires the agency to implement a compliance program and hire an independent organization to review Catholic Charities’ claims for behavioral health services under penalty of a potential exclusion from federal health care programs. The settlement announced today resolves allegations that between May 1, 2010 and December 31, 2013, Catholic Charities’ Behavioral Health Unit submitted false Medicaid claims for services that were rendered by a Catholic Charities practitioner with a lapsed license, services that did not comply with applicable supervision and documentation requirements, and services that Catholic Charities upcoded using billing codes for higher-paying services than were actually performed.
As part of the settlement, Catholic Charities acknowledged that it should have known that (1) the agency submitted claims for services rendered by a practitioner with a lapsed license between May 31, 2010 and August 17, 2011; and (2) the agency submitted claims, under prior management, using billing codes for longer therapy sessions than were provided to patients. Under the terms of the settlement agreement, Catholic Charities has agreed to implement and maintain a compliance program for at least two years. This compliance program requires the agency to do the following, among other things: report certain violations of state or federal criminal, civil, or administrative laws to the U.S. Attorney’s Office; implement written procedures to ensure the accuracy of billing codes that are used to submit claims to insurers; and create a means by which billing concerns and other issues can be reported anonymously and confidentially, without retribution or retaliation by Catholic Charities. Catholic Charities has also agreed to hire an independent firm to evaluate the agency’s billing practices and perform unannounced reviews of Catholic Charities’ claims for behavioral health services for at least two years.
If Catholic Charities materially defaults on its obligations under the settlement agreement, the U.S. Attorney’s Office will refer Catholic Charities to the U.S. Department of Health and Human Services, Office of Inspector General (“HHS-OIG”) for potential exclusion from federal health care programs, including Medicare and Medicaid. As part of the settlement, Catholic Charities has agreed not to contest any such exclusion.
