NDUTime Youth & Family Services: Missing Crisis and Day-Treatment Services

In the NDUTime Youth & Family Services fraud case, the company and its chief executive agreed to pay $700,000 to resolve allegations of false crisis-service and therapeutic day-treatment claims to Virginia Medicaid from 2013 through 2017. The allegations reached three parts of the work an insider could see: whether treatment happened, who delivered it, and who completed the initial assessment.

NDUTime was a mental health services provider in Henrico County, Virginia. It provided crisis intervention, crisis stabilization and therapeutic day treatment for children, among other services. The Department of Justice announced the settlement on September 16, 2021.

A billing employee may see a claim that looks complete. A counselor may know that the encounter never happened, or that the person doing the work lacked the required license. The NDUTime allegations put those different views of the same treatment claim together.

What NDUTime Allegedly Billed

The government alleged that NDUTime billed for services it never delivered, services not provided by a licensed counselor, and services based on initial assessments not completed by a licensed counselor. Each allegation concerns a different part of what Medicaid was paying for.

Services That Never Happened

The first allegation was that NDUTime submitted claims for services it did not actually render.

A worker familiar with the program may know whether the visit on the claim ever took place. The billing system can show an encounter that the counselor never had.

We see the absurdity in charging Medicaid for a visit that exists only on a claim. The bill gets there. The care does not.

Counseling Without the Required License

The second allegation concerned services not provided by a licensed counselor. In its account of the case, the Justice Department explained that Virginia law required certain services to be delivered by a licensed mental health professional.

That allegation follows the person who performed the work. A service may appear on a schedule and a patient may have attended, while the worker’s qualification still fails to match what the claim required. For an insider, the useful connection is between the service, the person who delivered it and that person’s qualification at the time.

Initial Assessments Without a Licensed Counselor

The assessment allegation reached the beginning of care. The Justice Department said initial assessments had to be made before services were provided, and alleged that NDUTime submitted claims based on assessments not completed by a licensed counselor.

Who completed the assessment is a separate question from who later delivered treatment. An intake worker might know how a patient entered the program. A treating counselor might know what happened afterward. Connecting those accounts to the billed services makes the allegation more specific than a general concern about staffing.

Why the Counselor and the Claim Have to Match

The company submitted the claims, and the government challenged who was providing the services and completing the assessments. For a behavioral healthcare worker, the question reaches beyond whether a colleague was on the payroll: was that person qualified for the service Medicaid was charged for?

The treatment record is where those accounts should meet. We examine how those pieces relate to the claim, including whether the assessment and the required qualification support the service being billed.

Missing Staff and Treatment in Other Medicaid Cases

Other Medicaid cases put the missing professional at the center of the billing problem.

In the St. Joseph’s Hospital Health Center mobile-crisis case, the hospital admitted that it improperly billed Medicaid for outreach visits conducted without a required member of its professional staff present. The missing professional was part of the payment issue. That admission gives the staffing comparison particular force: a visit occurred, but the required person was absent.

The Aspire Day Program allegations concerned education, recreation and lunch billed as covered day treatment, along with lower-level or unqualified staff represented as licensed professionals. Those allegations show why a day-treatment claim has to be connected to what the day contained and who supplied the represented care. Calling the day treatment does not do the treating.

A separate government complaint against Universal Health Services described an even sharper split between the professional named on a claim and the treatment allegedly supplied:

The allegation puts the clinician’s name and the missing work in the same sentence. For someone inside a program, the question is what that name represents: who assessed the patient, who directed care, and who actually provided it. Those are the connections that make staffing knowledge useful in a billing case.

The Whistleblower Cases Behind the Settlement

Two separate qui tam lawsuits by whistleblowers prompted the NDUTime investigation. The government then joined the cases and filed its own complaint. The United States and the Commonwealth of Virginia brought their claims against both the company and its chief executive under the federal False Claims Act and state law.

Federal prosecutors from the U.S. Attorney’s Office for the Eastern District of Virginia and state prosecutors from the Virginia Attorney General’s office investigated the case. The resolution involved the state office’s Medicaid Fraud Control Unit.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

What Evidence Is Needed to Prove Fraud?

For allegations like these, the evidence connects the billed service to the actual encounter, the worker who delivered it, the initial assessment and the required qualification. We work with the insider to understand where those accounts diverge and how the divergence affected claims.

Your knowledge may sit at just one of those points. A counselor knows the care delivered. An intake employee knows the assessment process. A billing specialist knows how the service became a claim. We bring those perspectives together around the alleged false billing, so the case reflects how the program actually worked.

You Know the Care Behind the Claim

If your behavioral health program bills Medicaid for care that never happened or for work by counselors without the required qualifications, speak with our whistleblower experts about what you see. We develop the case with you, bring in Medicaid fraud whistleblower lawyers who understand behavioral health billing, and stay beside you through the pursuit of a recovery.