Legal, Payers

Health Connect America Gets Fined $4.6M for Wrongful Billing of Medicaid

Health Connect America, a mental health company, improperly billed Virginia Medicaid for three different behavioral health services for children, according to the U.S. Attorney’s Office of Western District of Virginia.

Mental health company Health Connect America will pay more than $4.6 million “to resolve allegations that it billed Virginia Medicaid for services not provided,” the U.S. Attorney’s Office of Western District of Virginia announced Friday.

Franklin, Tennessee-based Health Connect America offers mental and behavioral health services to youth, individuals and families. It supports patients battling grief, anger management, family issues and substance use disorder. Health Connect America currently serves patients in Alabama, Georgia, Mississippi, Tennessee and Virginia.

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Health Connect America allegedly improperly billed Medicaid for three different behavioral health services for children, according to the Attorney’s Office. The first is called Therapeutic Day Treatment, which is a school-based program for kids with a variety of mental health conditions. The mental health company billed Virginia Medicaid for services to students who were absent, as well as during holidays and weather closures.

Another program it improperly billed Virginia Medicaid for is called Intensive In-home Services, a home-based mental health program for children who are “at risk of being removed from their home,” according to the Attorney’s Office. However, Health Connect America allegedly billed Virginia Medicaid for services by an employee who was engaged in a sexual relationship with a minor in Orange County, Virginia. The employee is currently serving a 10-year sentence.

Lastly, the company wrongly billed Virginia Medicaid for Behavioral Therapy Services, a specialized mental health treatment for kids with conditions like autism. Behavioral Therapy Services are required to be provided by specially-trained mental health professionals. However, Health Connect America billed for Behavioral Health Services by providers who were not “properly trained or credentialed” in Southwest Virginia.

The company also “used the name and National Provider Identifier (NPI) number of a properly-trained and credentialed mental health professional located in Northern Virginia who had never seen clients in Southwest Virginia,” the Attorney’s Office said.

“Health care providers have a responsibility to submit accurate and honest claims to federal health care 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), in a news release. “HHS-OIG is committed to safeguarding valuable taxpayer dollars and protecting the integrity of the Medicaid program.”

Health Connect America has agreed to five years of additional oversight and compliance. Compliance measures include unannounced audits and additional reporting requirements if there are situations of theft, fraud, abuse or neglect.

Not complying could lead to “criminal prosecution and contempt of court proceedings that could result in additional monetary sanctions and injunctive relief,” the Attorney’s Office stated.

Health Connect America did not return a request for comment.

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