The U.S. Attorney’s Office for the Eastern District of Kentucky has announced that Addiction Recovery Care, LLC (ARC) and related entities, had agreed to a $16,205,774.05 civil judgment resolving allegations that they violated the False Claims Act (FCA) through improper Kentucky Medicaid billing. ARC operates residential and outpatient drug rehabilitation facilities throughout Kentucky, and the entities provide behavioral and medical health care services to patients at those facilities.
According to the government, the entities overstated the qualifications of certain clinicians, billed certain group therapy as a higher-paying service, submitted duplicate office-visit claims, billed separately for services already included in a per diem payment, and billed for care-management services that did not satisfy Medicaid coverage requirements.
The government alleged that some psychotherapy, psychiatric-evaluation, and mental-health-assessment services were furnished by lower-level health care workers but billed as though the services had been provided by employees with higher-level licenses. According to the settlement announcement, those representations produced higher Medicaid reimbursement. The government also alleged that ARC represented that it had provided a higher-paying form of therapy when it had instead provided less expensive group therapy. These allegations underscore that a service code must accurately reflect both the service actually performed and the credentials of the individual who performed it.
Additionally, the DOJ claimed that ARC affiliates billed duplicate office visits and separately billed for office visits already reimbursed through an inclusive per diem rate. One affiliate also allegedly billed for care-management services that did not meet Kentucky Medicaid coverage requirements, including services performed by employees who lacked required credentials.
The resolution arose from a qui tam complaint filed in April 2023 by current and former ARC employees. During the government’s investigation, ARC self-disclosed that certain services should not have been billed, including services identified by the whistleblowers.
GWB represents healthcare providers in connection with government investigations and False Claims Act litigation. If you need assistance with such a matter, contact us today.
Get in Touch With Us
For more information or to arrange a consultation, please contact us by telephone at (404) 233-4171 or online by submitting the form below. The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship nor create an expectancy of a potential attorney-client relationship. Do not submit information which is confidential or time sensitive, as it may not be treated as such.