Health Connect America fined more than $4.6M for alleged Medicaid fraud

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Franklin, Tennessee-based Health Connect America, with locations in Big Stone Gap and Culpeper, Virginia, has agreed to pay more than $4.6 million to resolve allegations that it billed Virginia Medicaid for services not provided, according to the U.S. Department of Justice.

As part of the resolution, HCA also agreed to be subject to a period of five years of increased compliance and oversight, during which any failure to comply with its obligations may result in criminal prosecution and contempt of court proceedings – which could result in additional monetary sanctions and injunctive relief.

WHAT'S THE IMPACT?

The allegations involved HCA billing Medicaid improperly for three separate behavioral health services available to children who qualify. 

Therapeutic Day Treatment is a school-based program designed to assist children with various mental health diagnoses who need support during the school day. HCA allegedly billed Virginia Medicaid for providing services to students who were absent from school, and when school was not open due to holiday or weather closures.

Intensive In-Home Services is a home-based program designed to help children who have various mental health diagnoses and are at risk of being removed from their home. HCA allegedly billed Virginia Medicaid for intensive in-home services provided by an employee who was having a sexual relationship with a juvenile patient in Orange County, Virginia. That employee has since been prosecuted by state authorities and is serving a 10-year sentence.

Behavioral Therapy Services, meanwhile, is a specialized mental health service for children with various mental health diagnoses, including autism, and includes Applied Behavioral Analysis. Behavioral Therapy Services and Applied Behavioral Analysis must be provided by specifically-trained mental health professionals. The allegation is that HCA billed for Behavioral Health Services that were provided by individuals who were not properly trained or credentialed in Southwest Virginia, and used the name and National Provider Identifier number of a properly-trained and credentialed mental health professional located in Northern Virginia who had never seen clients in Southwest Virginia.

THE LARGER TREND

The DOJ said the agreement resolves HCA's potential criminal liability based on the investigation. As part of the resolution, HCA has committed to various compliance measures – including, but not limited to, increased compliance and audit requirements, unannounced audits and enhanced reporting requirements, if and when there are incidents of theft, fraud, abuse or neglect.

"Ensuring that healthcare providers accurately bill programs such as Medicaid and Medicare are one of the cornerstone functions of law enforcement," said United States Attorney Christopher R. Kavanaugh. "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."

ON THE RECORD

"Healthcare providers have a responsibility to submit accurate and honest claims to federal healthcare programs to ensure that these resources are available for eligible patients," said Maureen Dixon, special agent in charge at the Department of Health and Human Services, Office of Inspector General (HHS-OIG). "HHS-OIG is committed to safeguarding valuable taxpayer dollars and protecting the integrity of the Medicaid program."
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com