Psychological well being firm Well being Join America pays greater than $4.6 million “to resolve allegations that it billed Virginia Medicaid for providers not offered,” the U.S. Lawyer’s Workplace of Western District of Virginia Friday.
Franklin, Tennessee-based affords psychological and behavioral well being providers to youth, people and households. It helps sufferers battling grief, anger administration, household points and substance use dysfunction. Well being Join America at the moment serves sufferers in Alabama, Georgia, Mississippi, Tennessee and Virginia.
Well being Join America allegedly improperly billed Medicaid for 3 completely different behavioral well being providers for youngsters, in accordance with the Lawyer’s Workplace. The primary is known as Therapeutic Day Remedy, which is a school-based program for teenagers with a wide range of psychological well being situations. The psychological well being firm billed Virginia Medicaid for providers to college students who have been absent, in addition to throughout holidays and climate closures.
One other program it improperly billed Virginia Medicaid for is known as Intensive In-home Companies, a home-based psychological well being program for youngsters who’re “liable to being faraway from their residence,” in accordance with the Lawyer’s Workplace. Nevertheless, Well being Join America allegedly billed Virginia Medicaid for providers by an worker who was engaged in a sexual relationship with a minor in Orange County, Virginia. The worker is at the moment serving a 10-year sentence.
Lastly, the corporate wrongly billed Virginia Medicaid for Behavioral Remedy Companies, a specialised psychological well being remedy for teenagers with situations like autism. Behavioral Remedy Companies are required to be offered by specially-trained psychological well being professionals. Nevertheless, Well being Join America billed for Behavioral Well being Companies by suppliers who weren’t “correctly skilled or credentialed” in Southwest Virginia.
The corporate additionally “used the identify and Nationwide Supplier Identifier (NPI) variety of a properly-trained and credentialed psychological well being skilled positioned in Northern Virginia who had by no means seen shoppers in Southwest Virginia,” the Lawyer’s Workplace stated.
“Well being care suppliers have a accountability to submit correct and sincere claims to federal well being care packages to make sure that these sources can be found for eligible sufferers,” stated Maureen Dixon, particular agent in cost on the Division of Well being and Human Companies, Workplace of Inspector Basic (HHS-OIG), in a information launch. “HHS-OIG is dedicated to safeguarding invaluable taxpayer {dollars} and defending the integrity of the Medicaid program.”
Well being Join America has agreed to 5 years of extra oversight and compliance. Compliance measures embrace unannounced audits and extra reporting necessities if there are conditions of theft, fraud, abuse or neglect.
Not complying might result in “prison prosecution and contempt of court docket proceedings that would end in extra financial sanctions and injunctive aid,” the Lawyer’s Workplace said.
Well being Join America didn’t return a request for remark.
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