Substance Use Disorder Treatment Clinics to Pay More than $850,000 to Resolve Allegations They Knowingly Overbilled Medicaid for Office Visits

The United States and the Commonwealth of Virginia have reached an $863,934 civil settlement with certain substance use disorder treatment clinics serving patients from Virginia to resolve allegations that these clinics submitted false and fraudulent claims to the Medicaid program. The clinics – Crossroads Treatment Center of Petersburg P.C., ARS Treatment Centers of New Jersey P.C., Crossroads Treatment Center of Greensboro P.C. and Starting Point of Virginia P.C. – are part of a chain called Crossroads, which is headquartered in Greenville, South Carolina.

The United States and the Commonwealth contended that, from 2016 through mid-2023, the clinics submitted claims to Virginia Medicaid containing code 99215, which signifies a meeting with a patient involving at least two of the following three components: a comprehensive medical history, a comprehensive medical examination, and medical decision making of high complexity. However, the clinics knew the meetings were regular check-ins during substance use disorder treatment and did not meet those criteria. Of the $863,934 civil settlement, the United States will receive $356,891 and the Commonwealth will receive $507,043.

“Providers may bill only for the services that they actually provide,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will continue to protect the vital services provided by federal health care programs, including substance abuse disorder treatments, against those who seek to abuse them.”

“Submitting false claims to Medicaid undermines the integrity of the program and wastes valuable taxpayer dollars,” said Special Agent in Charge Tamala E. Miles with the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Working closely with our law enforcement partners, HHS-OIG remains committed to investigating providers who allegedly defraud federal health care programs.”

The United States’ investigation was prompted by a lawsuit filed under the whistleblower provisions of the False Claims Act, which permit private parties to sue on behalf of the government when they believe that defendants submitted false claims for government funds and to receive a share of any recovery. The settlement agreement in this case provides for the whistleblower, Diana France, a former Director of Network Management and Contracting for Crossroads, to receive $60,671 as her share of the federal recovery. The settlement agreement also provides for the whistleblower to receive a share of the Commonwealth’s recovery. The case is captioned United States ex rel. France v. Crossroads Treatment Ctrs., No. 6:21-cv-01263 (D.S.C.).

Senior Trial Counsel Albert P. Mayer of the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, and Assistant U.S. Attorney Nancy G. Cote for the District of South Carolina handled the matter, with assistance from HHS-OIG and several state attorney generals’ Medicaid fraud control units.

The United States’ allegations described above were allegations only. There was no determination of liability.

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Source: Justice.gov