Noble Home Health Care: Unlicensed Children’s Mental-Health Claims

In the Noble Home Health Care fraud case, the company and its owner agreed to pay $111,200 to resolve allegations of billing MaineCare for children’s mental-health services without the required license. The government alleged that the claims covered services to 45 children with mental-health diagnoses. For someone inside a provider’s billing or licensing operation, the point is what management was told, and what the company billed afterward.

The U.S. Attorney’s Office for the District of Maine announced the civil settlement on June 10, 2020. Noble Home Health Care, Inc., a Portland, Maine company, reached the agreement with the United States and the State of Maine to resolve False Claims Act allegations.

Children’s Mental-Health Claims Without the License

The government alleged that Noble billed MaineCare from May through September 2016 without the mental-health license the company needed to provide and bill for those services.

The missing qualification belonged to the company itself. In behavioral health, a company’s license, an individual clinician’s credentials and the organization’s payer enrollment answer different questions. Licensure covers the activity a provider may offer; enrollment concerns its relationship with the payer. Noble’s case turns on the company’s alleged lack of authority to offer the mental-health services for which it sought payment.

The person treating a patient, the organization submitting the claim and the owner directing the operation occupy different positions. A clinician may know what care was delivered. A billing employee may know what service the claim represented. A person handling licensing may know whether the company had authority to offer it.

Why MaineCare Licensure Mattered

MaineCare is Maine’s Medicaid program. The Justice Department’s announcement explained that the United States paid approximately two-thirds of its reimbursed claims. The alleged improper billing therefore reached federal money through a state program, which explains why both governments were parties to Noble’s civil settlement.

For an insider, the distinction is between the organization’s permission to offer a service and the qualifications of the person doing the work. We examine whose qualification the claim depended on, what work that qualification covered and what the claim said had been delivered.

The Today’s Youth settlement announced in April 2021 shows the individual-provider side of that problem. The government alleged that Today’s Youth billed Connecticut Medicaid as though licensed clinicians had rendered behavioral-health services when unlicensed providers had done the work. The announcement explained that supervision of an unlicensed worker did not satisfy that independent-practice program’s requirement about who delivered the service.

Noble’s alleged missing qualification belonged to the company itself. Today’s Youth’s alleged mismatch concerned the people delivering care. Both cases connect the qualification behind a health care claim to the money paid for it.

Repeated Warnings and the Owner’s Acknowledgment

Maine Department of Health and Human Services officials allegedly told Noble’s owner several times that the company could neither provide nor bill for mental-health services for its clients. The government’s account places that knowledge inside the company, with its owner, while billing continued for nearly five months.

The state allegedly said the company could not bill. MaineCare kept paying. We see public money continuing to leave the program after the warning had already reached the person directing the business. That gap is exactly where an employee’s knowledge of the decisions inside the business matters.

According to the Justice Department’s account of the allegations, Noble’s owner subsequently acknowledged to Maine DHHS that he had to repay MaineCare for services the company had provided without a license.

A former employee’s whistleblower complaint against Connex Family Services alleged that an owner planned to report wrongful billing submissions to Medicaid after learning of a worker’s fraud. The complaint described a clinical director’s response:

The whistleblower alleged that management understood what an audit might uncover and discouraged a report that could expose the billing. That is why someone who heard the conversation can matter as much as someone who processed the claims.

The same Connex complaint alleged that unlicensed people routinely prepared patient treatment plans. The whistleblower also described personally observing an owner perform unsupervised initial assessments. Those allegations bring the qualification issue into the work itself: who assessed the patient and who prepared the plan, before a claim ever reached Medicaid. They show why we look beyond the name on a bill to the people who actually delivered and directed the care.

Who Investigated the Noble Home Health Care Case?

The Department of Health and Human Services Office of Inspector General, the U.S. Attorney’s Office for the District of Maine and the Maine Attorney General’s Office investigated the Noble case. The state’s health department supplied the licensing warnings described in the Justice Department’s announcement.

What Evidence Does a Whistleblower Need?

Our whistleblower experts help you connect what you know about the care, the claims and management’s decisions. In a licensing-and-billing case like Noble’s, that means understanding which service the company billed and what its owner knew about the company’s authority to provide it.

Someone working with claims may see the services billed after a warning. Someone responsible for licensing may know what officials told the owner. Someone delivering care may know which staff actually performed the work. Those are different views of the same operation, and our work is to connect your view to the payment and the decisions behind it.

How Much of a Settlement Does a Whistleblower Get?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. If you recognize unlicensed billing or claims that continued after licensing warnings, speak to one of our whistleblower experts about the claims you saw go out.

You Know What Happened After the Warning

If you saw a licensing warning reach management while the claims kept going out, talk with our whistleblower experts about that decision. We work beside you to build the case around the billing and the people directing it, and bring in behavioral-health fraud whistleblower lawyers who understand provider qualifications and Medicaid payment. We stay with you as your knowledge becomes a case for recovering public money.