So Much for Caring

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41913416 - medicaid torn newspaper headline on cash

Medicaid provides comprehensive coverage for children with behavioral health needs, making treatment affordable for low income families. The owner of a former New Haven, Connecticut behavioral health clinician group deceptively called Caring Family Solutions carried out a Medicaid fraud scheme that stole $100,000 in a very systematic way. (So much for providing caring solutions for her vulnerable clients. Apparently, all she cared about was herself.)

The New Haven businesswoman purportedly provided behavioral health services in addition to temporary childcare, after-school programs, support groups for children and summer camps. While her former company’s website claimed that the business has helped over 300 children and families during their previous seven years of operation, it only took three years to illegally collect six figures in government benefits to which she was not entitled. Today’s fraudster started the scheme shortly after her business enrolled in the Connecticut Medical Assistance Program (CMAP) or Connecticut’s Medicaid program. (So, she was in it from the get-go. It wasn’t a mistake.)

A referral to the Connecticut Department of Social Services was the reason a state investigation was opened. It was discovered that the woman’s company submitted bogus claims for psychotherapy services allegedly provided to patients through CMAP. (The claims stated that the psychotherapy services were provided by licensed behavioral health providers, but as you might guess, they were not.)

Investigators also found that in some cases no psychotherapy services were provided at all. (Is that really surprising?) In fact, the patients were not even physically present on the dates when services were supposedly provided. Some of the services actually provided included homework assistance, support groups and recreational activities that were not reimbursable through CMAP, yet the business billed the services as psychotherapy. (That’s called upcharging.)

The owner of the former New Haven behavioral health clinician group agreed to settle with the state by paying back $100,000 for carrying out her Medicaid fraud scheme. The group will forfeit $12,409 in suspended payments, pay $25,000 immediately and repay the balance over time with interest. While this fraudster did not care about the children she was supposedly helping, the government did. Justice was served when this woman’s fraud scheme was exposed. It will be at least a decade before she can participate as a provider through CMAP. (She can be sure that the government will take care to watch her every move, ensuring that she and her business will never take advantage of Medicaid or vulnerable clients again.

Today’s “Fraud of the Day” is based on an article, New Haven behavioral health provider suspended, pays $100,000 settlement,” published by New Haven Register on January 18, 2019.  

HARTFORD — A former New Haven behavioral health clinician group and its owner have agreed to pay $100,000 and will be suspended from participating in Connecticut’s Medicaid program for 10 years for allegedly engaging in a systematic and long-term pattern of submitting false claims to the program, officials said in a release.

New Haven resident Lamaara Davis is the owner and CEO of the Davis Group, which conducted business in New Haven under the name “Caring Family Solutions” and provided, among other services, temporary child care, after-school programs, support groups for children and summer camps, according to the release from Attorney General William Tong and state Department of Social Services Commissioner Roderick L. Bremby. The Davis Group enrolled in the Connecticut Medical Assistance Program — the state’s Medicaid program — as a behavioral health clinician group in 2014.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.