Former children’s autism service provider pays over $2.7 million to resolve health care fraud allegations
HOUSTON – The former owner and sole shareholder of The Shape of Behavior (TSOB), a Texas-based provider of therapy services for children with autism, has agreed to pay to resolve allegations that the company submitted improper claims to the TRICARE program, announced Acting U.S. Attorney Jennifer B. Lowery.
Dr. Domonique Randall, 45, Spring, has now paid a total of $2,729,083.23.
TRICARE is an entitlement program for uniformed service members, retirees and their families around the world.
Authorities initiated an investigation after TRICARE’s managed care support contractor - Humana Military Program Integrity – uncovered alleged improper claims. These were for applied behavior analysis therapy to beneficiaries with autism spectrum disorder.
Today’s settlement resolves allegations that nine separate TSOB locations submitted claims to TRICARE that misrepresented the identity of the actual rendering providers, that medical records could not substantiate or when individual providers billed excessive hours on individual dates of service.
“The welfare of our service members and the extended Department of Defense (DoD) family is of vital importance to the DoD Inspector General,” said Acting Special Agent in Charge Gregory P. Shilling of the Defense Criminal Investigative Service’s (DCIS) Southwest Field Office. “This resolution is a testament to the collaboration between the DCIS and our partners in ensuring TRICARE beneficiaries receive the highest level of care from health care providers while also ensuring those providers are being stewards of valuable taxpayer resources.”
The Defense Health Agency - Office of Program Integrity, DCIS and Humana Military Program Integrity all assisted in the joint investigation resulting in the settlement announced today. Assistant U.S. Attorney Kenneth Shaitelman handled the matter on behalf of the United States.
The claims resolved by the settlement are allegations only and there has been no determination of liability.