Spokane, WA – Today, the Confederated Tribes of the Colville Reservation (CCT) and the United States of America, acting through the U.S. Department of Justice (DOJ) and on behalf of the Office of Inspector General of the Department of Health and Human Services (OIG-HHS), announced a voluntary settlement agreement reached by the parties relative to allegations that the Colville Tribes submitted false claims to Medicaid seeking the reimbursement of mental health counseling services that was purportedly provided by the Tribe’s Behavioral Health Unit – Youth Counseling services.
The CCT is a federally recognized, sovereign Indian tribe, with tribal offices located at Nespelem, Washington, on the Tribes’ reservation. In furtherance of the goals of the Indian Health Care Improvement Act (IHCIA) and to fulfill the United States’ trust and treaty obligations to the CCT’s members, the Secretary of HHS and the CCT entered into a Title I Contract and Annual Funding Agreement, on a government-to-government basis, to provide health and social services to tribal members and other eligible individuals. Thus, the CCT is entitled to bill federal health care programs for provided services.
Under the agreement, the Confederated Tribes of the Colville Reservation have agreed to pay $245,860 (Two Hundred Forty-Five Thousand, Eight Hundred Sixty Dollars) to resolve false claims allegations arising out of the Tribes’ billing irregularities that occurred from January 2010 through August 2010.
During that time, the CCT contracted with an independent mental health contractor to provide youth counseling services. The contractor submitted invoices to the CCT for payment of child mental health encounter sessions. The CCT used these invoices to generate claims that it submitted to the Washington State Medicaid Program for reimbursement. Medicaid administered payment of these encounter session claims with federal funds.
In 2010, the Federal Bureau of Investigation (FBI), along with the Medicaid Fraud Control Unit (MFCU) and the U.S. Attorney’s Office, began an investigation into allegations that the contractor falsely documented weekly billing invoices for alleged encounter sessions, which the contractor submitted to the CCT for child mental health counseling sessions which were either not provided or were not medically indicated or necessary.
The investigation found that the contractor conducted a 10-week summer group course, with the same curriculum, year after year, and for the same children. The contractor allegedly submitted invoices to the CCT indicating mental health sessions had been individually provided to each of the children. As alleged, the CCT submitted claims for payment of these false individual counseling sessions to Medicaid based on the falsified invoices.
The investigation determined that the group sessions were not clinically directed, did not address the patients’ diagnoses, and had little to no clinical value. The CCT was allegedly complacent in its supervision and review of their counseling contractor’s work.
While the CCT did not admit any wrongdoing, the Office of Inspector General for the U.S. Department of Health and Human Services (OIG-HHS) and the CCT agreed to a settlement that provides for performance of a Voluntary Tribal Compliance Agreement (VTCA), on a government‐to‐government basis, not only aims to enhance the health care services provided to CCT’s tribal members, but also supports CCT in fulfilling its’ obligations under applicable federal law. Per the VTCA, among other things, the CCI will designate a compliance officer and committee, will have an annual review performed by an independent review organization, will establish internal policies and procedures, and will annual reports with the OIG-HHS.
“This settlement shows both our commitment to protect tax payer dollars and the Colville Tribes’ commitment to providing quality and responsible health and health education services for its’ members,” said Michael C. Ormsby, United States Attorney for the Eastern District of Washington.
“Fraudulent schemes such as those alleged here drain scarce Medicaid dollars and jeopardize the program’s ability to provide necessary medical care,” said OIG-HHS’s Special Agent in Charge Steven J. Ryan. “Today’s settlement with CCT will help protect tribal children and the program upon which they depend.”
This case was investigated by the FBI, OIG-HHS, Washington State’s Medicaid Fraud Control Unit (MFCU), and federal prosecutors in the United States Attorney’s Office for the Eastern District of Washington.
See related case United States v. Debra Van Bunt-Oreiro, Cause No. 13-CR-00110-RMP (2014) and related press release at https://www.justice.gov/usao-edwa/pr/omak-mental-health-counselor-sentenced-five-years-probation-filing-false-income-tax