Attorney General: Stop Healthcare Fraud and Abuse

 

STOP HEALTHCARE FRAUD AND ABUSE

The State of Connecticut has many tools that may be used to fight healthcare fraud. One significant tool is the Connecticut False Claims Act (“CT FCA”)[1]. The Attorney General is authorized to investigate suspected violations of the CT FCA.[2]  Information gathered pursuant to a CT FCA investigation is CONFIDENTIAL and exempt from disclosure under the Freedom of Information Act.[3]

The CT FCA covers false claims against medical assistance programs administered by the Connecticut Department of Social Services. This includes medical assistance under the following programs: Medicaid, Charter Oak, Husky A, Husky B, CONNPACE, State Administered General Assistance (SAGA), and Connecticut AIDS Drug Assistance Program (CADAP), and all other DSS programs), the Office of the State Comptroller for all health programs including those for state employees and retirees, the Department on Aging, the Department of Children and Families, the Department of Developmental Services, the Department of Mental Health and Addiction Services, the Department of Public Health, the Department of Rehabilitation Services, the Office of Early Childhood and the Department of Administrative Services for Workers Compensation medical claims. Leave it to us to figure out whether or not your complaint is within the scope of the CT FCA, or other applicable law. If in doubt, report!

What is a false claim? Following are examples of fraud or abuse that could constitute a false claim:

  • Billing for services not rendered
  • Providing unnecessary services
  • Billing for non-covered services as covered services
  • Billing for more expensive services than those that are necessary (“upcoding”)
  • Billing separately for services that should be bundled together at a lower rate Duplicate billing
  • Altering a claim, or altering a document support a claim like a certificate of medical necessity Falsifying cost reports
  • Providing or receiving something of value (cash, gifts, services) in return for services or referrals for services (i.e. kickbacks)
  • Billing for brand-name drugs when generic drugs are dispensed
  • Off-label marketing of drugs or medical devices

Remedies:  The CT FCA authorizes the following remedies[4]:

  • Civil penalties of $5,500 to $11,000 per violation, with certain upwards adjustments
  • Treble damages—recovery of three times the amount of damages sustained by the State
  • Costs of investigation and prosecution of the false claims violation

Whistleblower Incentives:  The CT FCA authorizes the court to award to private persons who initiate court cases under the CT FCA awards of 15% to 30% of the State’s recovery, as well as reasonable expenses and attorney’s fees and costs against the defendant, which the court finds have been necessarily incurred. The amount of recovery may vary based on case specific considerations and the orders of the court.[5] The CT FCA also provides protection to whistleblowers from workplace retaliation.[6]

REPORT FRAUD OR ABUSE

Report healthcare fraud or abuse, including violations of the Connecticut False Claims Act, in any of the following ways:

Email - Complaint Form to ag.fraud@ct.gov 

Telephone Fraud Tips Line - call 1-860-808-5354

Fax - Fax Complaint Form to 1-860-808-5391

Mail - Mail Complaint Form (along with supporting information) to following address:

            Office of the Attorney General

            State of Connecticut

            Antitrust and Government Program Fraud Department

            FRAUD COMPLAINT

            P.O. Box 120

            Hartford, CT 06141-0120



[1] Conn. Gen. Stat. §4-274 et seq.

[2] Conn. Gen. Stat. §§4-61dd, §4-276

[3] Conn. Gen. Stat. §§1-210(b)(13), 4-61dd(a), 4-276.

[4] Conn. Gen. Stat. §4-275(b)

[5] Conn. Gen. Stat §4-278 (CT FCA privately initiated case prosecuted by AG); Conn. Gen. Stat. §4-279 (CT FCA privately initiated case declined by AG)

[6] Conn. Gen. Stat. §4-278