AG Jepsen: State Enters Settlement with
Tolland Psychiatrist Resolving False Claims Allegations
A Tolland psychiatrist will pay $404,798 to settle a civil False Claims Act lawsuit alleging that she submitted false claims for payments to Connecticut's Medicaid program. The resolution stems from a lawsuit and settlement agreement approved yesterday by a Hartford Superior Court judge, Attorney General George Jepsen said today.
The Attorney General alleged that, while enrolled as a behavioral health and psychiatric services provider in the Connecticut Medical Assistance Program (CMAP), Dr. Leela A. Panoor engaged in a long-term pattern of submitting "upcoded" claims to the state Department of Social Services (DSS) for services provided to her Medicaid patients.
The practice of "upcoding" occurs when a provider knowingly uses a higher-paying code on the claim form for a CMAP recipient to reflect the use of a more expensive service, procedure or device than was actually used or was medically necessary.
The state alleged that, from March 2010 to September 2013, while operating a private practice in Mansfield, Dr. Panoor submitted upcoded claims indicating that she provided Medicaid patients with both group counseling and either individual psychotherapy or a detailed examination on the same dates of service when, in fact, she did not provide psychotherapy or detailed examination sessions but instead provided medication management services or a brief meeting with the patient for the purpose of monitoring or changing a patient's drug prescription – services that are coded, and thus reimbursed, at lower payment rates.
Dr. Panoor has agreed to pay $404,798 to the CMAP to resolve the False Claims Act allegations; she has entered into a separate agreement with DSS that restricts her participation in CMAP to services provided as a performing provider employed by or contracted with an organization.
"This case demonstrates that enforcement of the False Claims Act continues to be a priority of my office," said Attorney General Jepsen. "The Connecticut Office of the Attorney General and our law enforcement partners are committed to protecting the public and vigorously pursuing all those who knowingly submit false claims affecting the Medicaid program."
Attorney General Jepsen thanked the DSS Office of Quality Assurance, the State of Connecticut Division of Criminal Justice Medicaid Fraud Control Unit and the United States Department of Health and Human Services Office of the Inspector General-Office of Investigations, for their assistance and coordination in this case.
"As administering agency for Medicaid in Connecticut, DSS works closely with our state and federal partners to safeguard the integrity of the program," said DSS Commissioner Roderick L. Bremby. "While this false claims case does not represent medical providers as a whole, it does highlight the fact that constant vigilance is necessary to protect taxpayer investments in public health coverage. We thank Attorney General Jepsen and his staff, the Division of Criminal Justice Medicaid Fraud Control Unit and the HHS Inspector General’s Office for their outstanding work in coordination with DSS quality assurance investigators."
"Medicaid is designed to provide health care services to some of the most vulnerable members of our society and it’s our agency’s mission to ensure Medicaid funds are spent properly," said Special Agent in Charge Phillip M. Coyne of the U.S. Department of Health and Human Services Office of Inspector General. "Working with our State partners, we will continue to hold accountable any medical professional who bills Medicaid for more intensive and expensive services than those actually provided just to enrich themselves."
Today's action is part of a larger effort by the State of Connecticut's Interagency Fraud Task Force, which was created in July 2013 to wage a coordinated and proactive effort to investigate and prosecute healthcare fraud directed at state healthcare and human service programs. The Task Force includes a number of Connecticut agencies and works with federal counterparts in the U. S. Attorney's Office and the U.S. Health and Human Services, Office of Inspector General – Office of Investigations. For more information about the Task Force, please visit www.fightfraud.ct.gov
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Antitrust and Government Program Fraud Department at 860-808-5040 or by email at firstname.lastname@example.org
; the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney at 860-258-5986 or by email at email@example.com
; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud
or by email at firstname.lastname@example.org
Forensic Fraud Examiner David Boucher and Assistant Attorney General Michael Cole, chief of the Antitrust and Government Program Fraud Department, assisted the Attorney General with this matter.
Jaclyn M. Falkowski