Behavioral Health Provider Pays $384K to Settle Allegations it Overbilled Connecticut Medicaid

United States Attorney Vanessa Roberts Avery and Connecticut Attorney General William Tong today announced that COMMUNITY MENTAL HEALTH AFFILIATES, INC. (“CMHA”), has entered into a civil settlement agreement with the federal and state governments in which it will pay $384,322 to resolve allegations it overbilled the Connecticut Medicaid program for certain behavioral health services.

CMHA is a behavioral health provider with a headquarters in New Britain and has 10 locations in northwestern and central Connecticut.  At one of its locations, Harvest House in New Britain, CMHA runs a group home for clients with serious and persistent mental illness.

CMHA provides Medicaid Rehabilitation Option (MRO) services to its clients residing at Harvest House.  MRO services are designed to help clients who have functional disabilities secondary to serious and persistent mental illness achieve maximum functioning in self-care and independent living.  In order to receive monthly MRO payments, a behavioral health provider, such as CMHA, must furnish clients with at least 40 hours of MRO services per month and document such services in accordance with Medicaid requirements.

The government alleges that CMHA submitted claims for MRO services to Connecticut Medicaid for certain clients for certain months at Harvest House and were paid the monthly fee for those services, but failed to document at least 40 hours of covered MRO services per month for the clients in question.

To resolve the governments’ common law claims, CMHA agreed to pay $384,322, which covers the time-period from January 2015 through December 2019.

The investigation of CMHA was initiated through the filing of a complaint under the whistleblower provisions of the federal and state False Claims Acts.  The relator (whistleblower) will receive 15 percent of the settlement, in the amount of $57,648.

The case related to this settlement is captioned United States and State of Connecticut ex rel. Lugli v. Community Mental Health Affiliates, Inc. (Docket No. 20-cv-1483).

This matter was investigated by the Office of Inspector General for the Department of Health and Human Services.  The case was prosecuted by Assistant United States Attorney Richard M. Molot, and by Assistant Attorney General Rick Porter of the Connecticut Office of the Attorney General.

People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS.