Comprehensive Psychiatric Services to Pay $2.75 Million in False Claims Act Settlement

Strategic Insights -

Comprehensive Psychiatric Services, a behavioral medicine service provider based in California, has agreed to pay $2.75 million to resolve allegations that it submitted false claims to government healthcare payors for certain psychotherapy services. The settlement, announced by the United States Attorney's Office for the Northern District of California, resolves allegations that the company submitted claims using "add-on" codes that require specific documentation, without adequately providing the services described by those codes. This lack of proper documentation resulted in the submission of fraudulent claims, which drained resources from American taxpayers who rely on Medicare and other government programs.

Key Takeaways:

  • Comprehensive Psychiatric Services has agreed to pay $2.75 million to resolve allegations of submitting false claims to government healthcare payors.
  • The settlement resolves allegations that the company submitted claims using "add-on" codes without providing the services described by those codes or sufficiently documenting them.
  • The company will pay $2,615,569.32 to the United States and $134,430.68 to the State of California.
  • The investigation and settlement involved a coordinated effort by multiple agencies, including the U.S. Attorney's Office for the Northern District of California, HHS-OIG, DCIS, VA OIG, OPM OIG, and the California Department of Justice.
  • The settlement sends a clear message that healthcare providers must abide by the rules and submit proper claims for care that was actually rendered.
  • The investigation highlighted the importance of maintaining the integrity of federal health care programs, including the Federal Employees Health Benefits Program.
  • The settlement demonstrates the commitment of law enforcement agencies to investigate and hold accountable healthcare providers that seek to enrich themselves at the expense of American taxpayers.

Statistics:

  • $2,750,000: The total amount that Comprehensive Psychiatric Services has agreed to pay in the settlement.
  • $2,615,569.32: The amount that the company will pay to the United States.
  • $134,430.68: The amount that the company will pay to the State of California.
  • 2015-2022: The time period during which Comprehensive Psychiatric Services allegedly submitted fraudulent claims.
  • 7.8 million: The number of Americans who rely on Medicare and other government programs for healthcare coverage (Source: Kaiser Family Foundation).

Sources:

  • United States Attorney's Office for the Northern District of California
  • HHS-OIG
  • DCIS
  • VA OIG
  • OPM OIG
  • California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse