Behavioral health provider Health Connect America will pay $4.6 million to resolve allegations that it improperly billed Virginia's Medicaid program, the Department of Justice (DOJ) said Friday.
As part of the agreement, Health Connect America will also be subject to five years of additional oversight and compliance, and, should the company fail to comply with any of its obligations, it could lead to additional criminal prosecution and further fees, according to the DOJ announcement.
Health Connect America allegedly billed Medicaid improperly for three different behavioral health services for children, the DOJ said. Therapeutic Day Treatment is a program offered in schools that assists students with mental health needs who need support during the day. The DOJ said that the company billed Medicaid for services provided to students who were absent or on days the school was closed for holidays or due to weather.
Health Connect America also offers Intensive In-Home Services, which is a home-based program for children with behavioral health needs who are at risk of being removed from their homes. The DOJ said Health Connect America billed Medicaid for services provided in the program by an employee who has engaged in a sexual relationship with a juvenile patient.
“Ensuring that healthcare providers accurately bill programs such as Medicaid and Medicare are one of the cornerstone functions of law enforcement,” U.S. Attorney Christopher R. Kavanaugh said in the release. “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.”
The final program at question in the case, Behavioral Therapy Services, provides specialized mental health services to children with several diagnoses, including autism. The DOJ said that Health Connect America billed for services under this program that were provided by mental health professionals who were not properly trained or credentialed in southwest Virginia under the name and National Provider Identifier number of clinicians based in northern Virginia who were appropriately trained but had not seen the patients.
“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 in the release.