United States Obtains $1.65 Million Resolution for Fraudulent Medicaid Billing Against Behavioral Health Clinic in Northeast Philadelphia
The Clinic Will Also be Prohibited From Participating in Federal Healthcare Programs
PHILADELPHIA – United States Attorney William M. McSwain announced today that Tree of Life, Inc., and its owners and operators, Ada and Victor Vidal, agreed to settle allegations under the False Claims Act and Anti-Kickback Statute that they submitted thousands of fraudulent Medicaid claims for outpatient mental health services that were never rendered to their patients, including forgery of psychiatrists’ and therapists’ signatures on patient progress notes and treatment plans. As part of the settlement with the United States, Tree of Life and the Vidals agreed to pay $1.65 million and will be excluded from participating in federal healthcare programs. As a result, Tree of Life has closed its operations effective December 31, 2019.
Tree of Life was a for-profit, behavioral health clinic in Northeast Philadelphia that provided outpatient psychiatric and psychotherapy mental health services to individuals, including to low income patients. Between 2008 and 2013, Tree of Life allegedly submitted thousands of fraudulent Medicaid claims for outpatient mental health services. Specifically, Tree of Life billed Medicaid for services never rendered, billed Medicaid for falsely inflated services, created false patient progress notes and billing sheets, and forged psychiatrists’ and therapists’ signatures on patient progress notes and treatment plans. Tree of Life also allegedly submitted billing for therapy provided by unqualified individuals and the clinic paid kickbacks to a social worker for referrals of patients.
The government further contends that Tree of Life’s fraudulent scheme included the submission of bogus claims for therapy sessions provided to clients who were hospitalized at the time of the alleged therapy session, submission of claims for therapy sessions provided by therapists who no longer worked for Tree of Life at the time of the alleged therapy session, and submission of claims for therapy sessions allegedly provided on days when the office was closed. Tree of Life even submitted claims for clients who were deceased at the time of the alleged therapy. As a consequence, federal healthcare payers, including Medicaid, overpaid Tree of Life by millions of dollars.
“The fraud in this case is particularly egregious as it affects the treatment and care of low-income Philadelphians seeking mental health services,” said U.S. Attorney McSwain. “Receiving payments from Medicaid and not providing the billed services to those individuals who deserve appropriate treatment cheats those patients who need care, in addition to defrauding the federal government and therefore, American taxpayers. This resolution represents our commitment to holding accountable those who engage in fraud that affects the residents of Philadelphia and the Eastern District of Pennsylvania.”
“Exclusion is an important tool in our ongoing battle against health care fraud,” said Maureen R. Dixon, Special Agent in Charge of the Office of the Inspector General for the U.S. Department of Health and Human Services. “We will continue to work closely with the United States Attorney’s Office to ensure the integrity of taxpayer funds and to protect beneficiaries of federal healthcare programs, while excluding from federal programs those providers who engage in fraud.” Under the terms of the Settlement Agreement, Tree of Life agreed to be excluded for 25 years, Ada Vidal agreed to be excluded for 20 years, and Victor Vidal agreed to be excluded for 15 years.
This settlement resolved a lawsuit filed under the False Claims Act in the U.S. District Court for the Eastern District of Pennsylvania by the former Clinical Director of Tree of Life, Erika Desjardins. Under the qui tam or whistleblower provisions of the False Claims Act, private citizens are permitted to bring lawsuits on behalf of the United States and obtain a portion of the government’s recovery. The False Claims Act also permits the government to intervene and take over the lawsuit, which occurred in this case. The qui tam complaint was filed by Robert A. Davitch, Esquire of Sidkoff, Pincus & Green, P.C. and Sidney L. Gold, Esquire of Sidney L. Gold & Associates, P.C. “We thank the relator and the relator’s counsel for their invaluable contribution in this case. Without this type of information from citizens, detecting fraud and conserving government program funds would be much more difficult,” said U.S. Attorney McSwain. The whistleblower in this case, Ms. Desjardins, will receive $330,000 as her share of the recovery. She allegedly confronted Ada Vidal about the fraud and was allegedly fired for refusing to participate in the scheme.
The government’s resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
This matter was investigated by the U.S. Department of Health and Human Services’ Office of Inspector General. For the U.S. Attorney’s Office, the investigation and settlement were handled by Assistant U.S. Attorney Veronica J. Finkelstein and health care fraud auditor George Niedzwicki. Additional assistance was provided by health care fraud auditors Denis Cooke and Dawn Wiggins.
The case is captioned Erika Desjardins v. Tree of Life Behavioral Services, Inc.; Tree of Life Professional Behavioral Health Services, Inc.; and Tree of Life Professional Behavioral Health Systems, Civil Action No. 14-2039 (E.D. Pa.). The claims resolved by this settlement are allegations only and there has been no determination of liability.