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June 14, 2024

Behavioral health company, CEO pay $4.6M to settle telehealth billing fraud allegations

A behavioral health company that operates in Connecticut has agreed to pay $4.6 million in a civil settlement with the federal government over allegations that the business fraudulently and improperly submitted claims to Medicare and Connecticut Medicaid.

Authorities say Supportive Care Holdings LLC, and several affiliates, submitted false claims for psychological services provided to nursing home residents via telehealth.

The improper claims were for “telehealth originating site facility fees.”
 
Healthcare coding allows payment for a “telehealth originating site facility fee” in addition to the professional fee paid to the provider of psychological services. However, it should only be billed by the originating site when the facility provides administrative and clinical support to the patient.

Authorities say that, between 2019 and 2023, Supportive Care and its affiliates, along with their CEO Joseph “Dov” Newmark, submitted claims for Medicare and Medicaid beneficiaries “residing in nursing homes” who had actually been transferred to hospitals.

The settlement resolves the federal government’s allegations.

“As telehealth plays an increasingly important role in our healthcare system, it is critical that healthcare providers follow the relevant rules and bill for such services accurately and honestly,” said U.S. Attorney for the District of Connecticut Vanessa Roberts Avery. “The U.S. Attorney’s Office will vigorously investigate and enforce the law against any provider that submits fraudulent claims related to telehealth services, as this misconduct increases the cost of health care for all of us.”

This matter was investigated by the U.S. Department of Health and Human Services, Office of Inspector General. 

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