January 18, 2019

Behavioral health provider to pay $100K over false-claim charges

A former New Haven behavioral-health clinician group and its owner have agreed to pay $100,000 and will be suspended from participating in the state's Medicaid program for ten years for an alleged "long-term pattern of submitting false claims to the program," officials said.

State Attorney General William Tong and state Department of Social Services (DSS) Commissioner Roderick L. Bremby said Thursday that Lamaara Davis of New Haven and her company, the Davis Group LLC, submitted claims to the Connecticut Medicaid Assistance Program (CMAP) for psychotherapy services provided by unlicensed persons, in violation of program regulations. In other cases, claims were submitted for services never provided, authorities said.

Doing business as "Caring Family Solutions," the Davis Group provided child care, afterschool programs and support groups for children and summer camps. The business is no longer in operation, state officials said.

"We take very seriously allegations of fraud and abuse in our taxpayer-funded health-care programs," Tong said in a statement. "Services performed by unlicensed providers expose Medicaid patients to substandard care and undermine the integrity of our health-care system. When providers engage in false and fraudulent schemes, they will be held accountable by my office."

A state investigation sparked by a fraud referral from DSS revealed that between April 2014 and April 2017, the Davis Group submitted claims for psychotherapy services allegedly provided to CMAP patients by licensed behavioral health providers. The state charged that most of those services were in fact provided by unlicensed persons.

The investigation also revealed that psychotherapy services were in some cases not provided to patients at all and patients were not physically present on the service dates listed in the claims, according to officials. In other instances, investigators discovered that services provided were not psychotherapy services, but services such as homework assistance, support groups or recreational activities not eligible for Medicaid reimbursement.

In addition to the 10-year suspension from the state's Medicaid program, Davis and the Davis Group agreed in the settlement to pay $100,000 by forfeiting $12,409 in suspended payments, paying $25,000 immediately and repaying the balance over time with interest.

The settlement funds will be returned to the CMAP program, officials said.

Contact Michael C. Bingham at mbingham@newhavenbiz.com

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