Mental health services providers pay over a million to settle false claims liability

HOUSTON – Two mental health care providers in the South Texas area have agreed to pay $1,083,000 to resolve False Claims Act (FCA) allegations regarding the submission of claims to Medicare, TRICARE and Medicaid that non-physician personnel rendered, announced U.S. Attorney Alamdar S. Hamdani.

From 2017 through 2020, Texas Behavioral Health PLLC (TBH) and United Psychiatry Institute LLC (UPI) allegedly engaged in a pattern and practice of falsely billing Medicare Part B.

According to the allegations, TBH and UPI would submit claims for mental health services that physicians had not rendered or not directly supervised as Medicare regulations require. Some services occurred on dates when the physicians were traveling outside of the United States and thus unable to provide the services. Others allegedly occurred at times when it was not logistically possible for the physicians to have rendered them or directly supervised the services themselves due to the sheer volume of patients at multiple office locations located in and around the Houston area.

Certain non-physician practitioners can provide mental health services but must have their own benefit categories and must bill the government programs directly using their own provider numbers. This did not happen in this case, according to the allegations. As a result of the alleged improper billing, Medicare, TRICARE and Medicaid reimbursed TBH and UPI at the higher physician rate. 

“For a system to provide affordable mental health services, it’s important for healthcare providers to give accurate information about who is providing the services - not  supply misinformation in an attempt to fleece that system,” said Hamdani. “My office will continue to hold healthcare providers accountable when they get reimbursed at a higher rate due to alleged improper or fraudulent billing practices.”

“As evidenced by recent settlements and indictments, healthcare fraud and abuse of our federally funded healthcare system is rampant,” said Special Agent in Charge Douglas Williams of the FBI Houston Field Office. “Too many providers are taking advantage of the mental health crisis and patient beneficiaries to bilk the system for millions of dollars. Ultimately, we all pay the price for their deceit in the form of higher premiums and out-of-pocket expenses. We encourage anyone who has information about healthcare fraud to please speak up and report it to the FBI.”

“Our federal health care system relies on the fundamental principle that providers bill correctly and adhere to the rules. Taxpayers who fund these programs deserve nothing less,” said Special Agent in Charge Jason E. Meadows of the Department of Health and Human Services - Office of Inspector General (DHHS-OIG). “We will continue to collaborate with our law enforcement partners and prosecutors to ensure that those who submit false claims to Medicare are held accountable and that the Medicare trust fund is restored.”

The settlement stems from a qui tam or whistleblower complaint filed under the FCA, which permits a party to file an action on behalf of the United States and receive a portion of any recover. The qui tam case is United States ex rel. Gonzalez v. Texas Behavioral Health PLLC et al. The whistleblower will receive 17% of the proceeds from the settlement.

The U.S. Attorney’s Office for the Southern District of Texas and FBI conducted the investigation with assistance from DHHS – OIG and Texas Attorney General’s Office – Civil Medicaid Fraud Division. Assistant U.S. Attorney Melissa Green handled the matter.