United States and State Of Oklahoma Obtain $4.7 Million Judgment Against Behavioral Health Counseling Company and Its Owner for Submitting False Claims
Both Company and Owner Excluded from Participation in Medicaid/Medicare Programs for Five Years
Oklahoma City, Oklahoma – Mark A. Yancey, Acting United States Attorney for the Western District of Oklahoma, and E. Scott Pruitt, Attorney General for the State of Oklahoma, jointly announce that a judgment for $4,752,101.50 has been entered against LXE Counseling, LLC ("LXE") and Lexie Darlene George a/k/a Lexie Darlene Batchelor ("Batchelor") in a civil qui tam "whistleblower" lawsuit for submitting false claims related to behavioral health counseling to Medicaid patients in Oklahoma.
LXE is an Oklahoma limited liability corporation headquartered in Atoka, Oklahoma, that provides behavioral and mental health counseling in various offices throughout the state. Batchelor is the owner and CEO of LXE. LXE and Batchelor provided behavioral health psychotherapy and rehabilitation services to those who could not afford medical services under Oklahoma Medicaid ("SoonerCare"), which is a jointly funded program by the federal and state government administered by the Oklahoma Health Care Authority ("OHCA").
On November 5, 2015, the United States and State of Oklahoma intervened in the lawsuit styled United States and State of Oklahoma ex. rel. Pittman, et al., v. LXE Counseling, LLC, et al. (Case No. CIV-13-1129-R) and asserted claims for violations of the federal False Claims Act, the Oklahoma Medicaid False Claims Act, the Oklahoma Medicaid Program Integrity Act, and common law claims. The judgment entered today was on the government’s specific claims that LXE and Batchelor submitted or cause to be submitted the following false Medicaid claims to OHCA:
a. claims for services provided by persons not qualified to provide those services;
b. claims for services where the defendants altered dates or times of services or altered service codes to make otherwise ineligible claims eligible for reimbursement;
c. claims for face-to-face services that were double-billed for the same dates and times by the same person (i.e. using variations of Defendant Bachelor’s name);
d. claims for face-to-face services performed by Batchelor while she was instead attending a funeral, a wedding, or on trips;
e. claims for telemedicine services when LXE and its providers were not authorized or approved by OHCA to provide telemedicine services; and
f. claims for rehabilitation services provided to patients who never received any psychotherapy services, despite representations on LXE’s treatment plans that these services were necessary and OHCA regulations that only allows rehabilitation services to be provided as adjunct services to compliment psychotherapy.
United States District Judge David Russell entered a judgment today against LXE and Batchelor for a total of $4,752,101.50. Of that amount, $4,631,101.50 is for triple the amount of false claims and $121,000 is for penalties, as provided under the False Claims Act and the Oklahoma Medicaid False Claims Act. In addition to the monetary judgment, LXE and Batchelor entered into an agreement with United States Department of Health and Human Services Office of Inspector General whereby each of them will be excluded nationally from participation in the Medicaid and Medicare programs for five years.
This case is the result of a joint investigation by the Oklahoma Medicaid Fraud Control Unit and the United States Department of Health and Human Services Office of Inspector General. The case is being prosecuted by Assistant United States Attorneys Bob Troester and Amanda Johnson together with Assistant Attorneys General Niki Batt and Christopher Robinson.