Amvik Solutions: The Wrong Name on the Medicaid Claim

Amvik Solutions paid $153,300 to the federal government to resolve allegations that it falsely identified the rendering provider on Connecticut Medicaid claims for autism therapy. The settlement covered conduct from October 3, 2019 through October 1, 2020. The government alleged that the wrong Board Certified Behavior Analyst appeared on claims Amvik submitted for Helping Hands Academy. For someone who knows the billing system or the treatment schedule, that is the question at the heart of this case: whose work did the claim represent?

Amvik Solutions, LLC, based in Birmingham, Alabama, offered billing, claims and collections services to healthcare providers. According to the Justice Department’s account, it used its proprietary WebABA software to serve applied behavior analysis providers throughout the United States. Helping Hands Academy, LLC was its client, a Bridgeport provider treating children with autism. Helping Hands hired Amvik to handle its billing and claims in 2018.

The Amvik Solutions WebABA Fraud Case

The government alleged that Amvik submitted Helping Hands claims identifying the incorrect BCBA as the rendering provider. According to the government, the incorrect identity caused Connecticut Medicaid to pay claims it otherwise would not have paid.

We see the absurdity in the government’s allegation: Medicaid paid for children’s therapy because the bill named the wrong clinician. A clinician’s name doing financial work.

In ABA billing, the useful comparison runs from authorization and attendance through treatment time and staff qualifications to the billed service. A rendering name belongs alongside that account of the care, where we can compare it with the person who did the work.

The Amvik allegation centers on that last connection: the person identified as rendering the care and the claim sent to Medicaid. For an insider, knowing which clinician actually did the work can explain a discrepancy that the submitted claim alone conceals.

The Billing Company Had Its Own Role

Amvik was the company that settled the government’s allegations about submitting the claims. Helping Hands was the ABA provider that retained it. The clinical business and the business handling its claims occupied different places in the same payment chain.

A clinician’s certification, the provider organization’s Medicaid enrollment and its authority to bill answer different questions. Our review keeps those roles separate.

For a comparable case, we would connect the submitted rendering provider field to the service date, treatment record, staff schedule and worker’s qualifications. The payment record completes the comparison by showing which claims the program paid. The useful connection is between a particular claim, the care it represents and the people responsible for putting that account before the payer.

A clinician may recognize a name that does not match the treatment. Someone in billing may understand how that name reached the claim. Those are different views of the same transaction, and bringing them together is part of building a whistleblower case. The Amvik settlement gives billing-company employees a concrete reason to take their own knowledge seriously: the company handling the claims had a role the government pursued in its own right.

Other ABA Cases Put Provider Identity Beside the Treatment Record

Other ABA settlements show rendering identity appearing alongside disputes about time, service type and whether treatment occurred. The name on the bill is part of the treatment account.

In the Exemplary Behavior settlement, the company and its principal resolved allegations about claims submitted to TRICARE for children’s therapy. The government alleged billing for services not rendered by the billing provider and group therapy billed as individual therapy. Those allegations connect the person named on a claim to the kind of treatment the bill represents.

The Shape of Behavior’s former owner and sole shareholder settled allegations involving the company’s TRICARE claims. The government alleged that claims from nine locations misrepresented the actual rendering providers, lacked support in medical records or attributed excessive hours to individual providers on particular dates. Humana Military Program Integrity, TRICARE’s managed care support contractor, uncovered the alleged improper claims.

Early Autism Project’s settlement shows why the worker’s actual function matters too. The government alleged that therapists had to reserve billable time so the company could bill South Carolina Medicaid for Regional Leads and Regional Coordinators. Those staff allegedly performed administrative and management functions rather than actively working with the child whose hours were used. The alleged arrangement turned time allocated to a child’s treatment into a way to bill for running the business.

The government also alleged that Early Autism Project allowed therapists to pad hours billed to TRICARE and South Carolina Medicaid, so those programs paid for therapy that never occurred. The disputed hours carried both the description of treatment and a demand for payment.

For us, these cases put the same practical question in different forms: does the claim describe the work that the named person actually performed? The schedule, service record and claim can tell different stories. Someone inside the operation may know why.

The Amvik Settlement and the Whistleblower Opportunity

The U.S. Attorney’s Office for the District of Connecticut announced the civil False Claims Act settlement on January 13, 2023. The Department of Health and Human Services Office of Inspector General and the FBI investigated the case.

The Early Autism Project civil investigation, by comparison, arose from a former employee’s False Claims Act lawsuit.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. If your work gives you a view of how a provider’s name is selected, what treatment occurred and what Medicaid was told, we can assess those connections with you.

You Know Whose Work Was Billed

If the clinician on a Medicaid claim differs from the person whose work you know, talk with our whistleblower experts about the billing you saw. We build the case with you around the treatment, the claim and the decisions behind it, and bring in health care fraud whistleblower lawyers who understand ABA billing. We stay with you from the first conversation, working toward your strongest ABA billing whistleblower case.