Health Connect America Fined Over $4.6 Million for Improper Billing Practices

ABINGDON, Va. – Health Connect America, (HCA) headquartered in Franklin, Tennessee with locations in Big Stone Gap and Culpeper, Virginia, has agreed to pay $4,611,375 to resolve allegations that it billed Virginia Medicaid for services not provided. As part of the resolution, HCA further agreed to be subject to a period of 5 years of increased compliance and oversight, during which any failure to comply with its obligations may result in criminal prosecution and contempt of court proceedings that could result in additional monetary sanctions and injunctive relief.

The allegations involved HCA billing Medicaid improperly for three separate behavioral health services available to children who qualify. Therapeutic Day Treatment is a school-based program designed to assist children with various mental health diagnoses who need support during the school day.  HCA billed Virginia Medicaid for providing services to students who were absent from school, and when school was not open due to holiday or weather closures.

Intensive In-Home Services is a home-based program designed to help children who have various mental health diagnoses and are at risk of being removed from their home.  HCA billed Virginia Medicaid for intensive in-home services provided by an employee who was having a sexual relationship with a juvenile patient in Orange County, Virginia. That employee has since been prosecuted by state authorities and is serving a 10-year sentence.

Behavioral Therapy Services is a specialized mental health service for children with various mental health diagnoses, including autism, and includes Applied Behavioral Analysis.  Behavioral Therapy Services and Applied Behavioral Analysis must be provided by specifically-trained mental health professionals.  HCA billed for Behavioral Health Services that were provided by individuals who were not properly trained or credentialed in Southwest Virginia, and used the name and National Provider Identifier (NPI) number of a properly-trained and credentialed mental health professional located in Northern Virginia who had never seen clients in Southwest Virginia. 

“Ensuring that healthcare providers accurately bill programs such as Medicaid and Medicare are one of the cornerstone functions of law enforcement,” United States Attorney Christopher R. Kavanaugh said today. “When providers fail in that mission, we must hold them accountable. I am grateful to all those who worked on this matter and brought it to a just conclusion.”

“Health Connect America tried to charge Virginia Medicaid for child behavioral health services they never performed. I'm proud of the collaboration between my office and our federal partners in reaching an agreement and bringing justice,” said Virginia Attorney General Jason Miyares.

“Health care providers have a responsibility to submit accurate and honest claims to federal health care programs to ensure that these resources are available for eligible patients,” said Maureen Dixon, Special Agent in Charge at the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG is committed to safeguarding valuable taxpayer dollars and protecting the integrity of the Medicaid program.”

 The agreement resolves HCA’s potential criminal liability based on the investigation. As part of the resolution, HCA has committed  to various compliance measures, including, but not limited to, increased compliance and audit requirements, unannounced audits, and enhanced reporting requirements if and when there are incidents of theft, fraud, abuse, or neglect

The resolutions obtained in this matter were the result of a coordinated effort among the United States Attorney’s Office for the Western District of Virginia, the Virginia Attorney General’s Office Medicaid Fraud Control Unit, and the United States Department of Health and Human Services-Office of the Inspector General.

Special Assistant United States Attorney Janine M. Myatt, Assistant Attorney General with the Virginia Attorney General’s Office, and Assistant U.S. Attorney Randy Ramseyer represented the government in this matter.