Post Date: March 15, 2017       Topics: Claims,  Coding and Billing / Fraud Abuse

A sovereign Indian tribe recently agreed to pay $245,000 and entered into a five year Compliance Agreement with the Office of the Inspector General to settle allegations that it submitted false claims to Washington State Medicaid for child mental health counseling services.

The tribe contracted with an independent mental health counselor (“contractor”) who submitted invoices to the tribe. The contractor submitted claims for individual mental health sessions for children participating in a 10-week summer group course. The tribe used the contractor’s invoices to generate claims submitted to Medicaid for reimbursement.

An investigation by the Federal Bureau of Investigation (FBI), along with the Medicaid Fraud Control Unit (MFCU) and the U.S. Attorney’s Office found that the contractor did not provide the individual mental health services listed on the invoices. In addition, the investigation found that the group sessions were not clinically directed, did not address the patients’ diagnoses, and had little to no clinical value. The investigation found that the tribe was complacent in its supervision and review of the counseling contractor’s work.

Read the press release.