Addiction Care Interventions / A.R.E.B.A.-Casriel: Paid Referrals and Photocopied Physician Signatures

The Addiction Care Interventions / A.R.E.B.A.-Casriel fraud case produced a $6 million civil settlement over alleged recruitment kickbacks and falsified Medicaid admissions forms. The New York City treatment provider and its primary owner and former CEO admitted specific conduct involving drivers rewarded for bringing in patients, an employee paid as a translator who supplied referrals, and admissions staff using photocopied physician signatures.

A.R.E.B.A.-Casriel Inc. operated as Addiction Care Interventions Chemical Dependency Treatment Centers, known as ACI. The government joined a private whistleblower’s case under the False Claims Act. The Justice Department announced the settlement on December 21, 2020.

Drivers Paid to Bring in New Patients

ACI admitted that it financially rewarded drivers for bringing new patients into its inpatient treatment program. From January 2014 through December 2019, its drivers identified, recruited, and transported patients. They used unmarked vehicles and picked people up from parks, train stations, shelters, hospitals, under bridges, and other substance abuse treatment centers. The people they brought in were often homeless.

ACI admitted paying the driver who brought in the most new patients an annual salary of more than $200,000, along with a bonus of thousands of dollars. The government’s complaint alleged that drivers had to pick up a certain number of potential patients to qualify for a raise, and that their solicitation accounted for most new enrollments in the inpatient program.

The complaint also alleged that drivers sometimes offered food, cash, money to buy drugs, or alcohol to persuade people to enroll. ACI and its owner admitted that management learned of allegations that certain drivers gave potential patients money, drugs, or alcohol, then failed to investigate adequately or take appropriate corrective action.

We see an ugly bargain in that allegation: offering someone alcohol or money for drugs to bring them into addiction care. The admitted management failure puts the decisions inside the treatment center alongside what the drivers allegedly offered on the street.

Patient brokering can begin before a patient reaches the admissions desk. Here, the business rewarded the person who brought the patient through the door. The complaint’s pickup targets and the admitted compensation show why a transportation payroll matters to a Medicaid fraud case.

A separate settlement involving Turning Point Care Center shows another way transportation became part of a referral case. In July 2020, the government resolved allegations that the Georgia provider offered free or discounted transportation to induce Medicare and Medicaid beneficiaries to use its services. ACI’s case adds the driver’s own financial incentive and management’s admitted failure to respond to reports of inducements.

A Translator’s Job That Delivered Referrals

ACI admitted creating a part-time translator position for someone who also worked at an organization that referred people to substance abuse treatment as an alternative to incarceration. The position began in October 2012. Throughout her employment, the employee supplied ACI managers with lists of people the other organization was referring to ACI.

The government alleged that the Spanish translator position was a sham whose real purpose was primarily to supply patient referrals. According to its complaint, the employee remained on the payroll until March 2017 and received more than $75,000. The settlement admissions explain how little translation went with that pay:

The translation stopped. The payroll did not.

An insider could recognize the difference between the job on a payroll record and the work reaching managers. In this case, the admitted work included referral lists from someone employed by the organization directing those patients to treatment. The government’s allegation connected the pay to that access.

Addiction treatment admissions can involve benefits verification, insurer communications, screening, facility selection, and logistics before care begins. AAC Holdings described those functions in its 2018 account of its centralized admissions operation.

At ACI, the employee’s position at a referring organization put her at the point where patients were directed to a provider. Her ACI payroll record and the lists she supplied described different sides of the same relationship. We would want to understand both with an insider who knew the arrangement.

Copied Physician Signatures Supported Medicaid Claims

ACI admitted that, from July 2012 through July 2013, it took in certain patients without a proper evaluation by a qualified health care professional. Admissions staff who lacked those qualifications performed the assessments and completed the admissions criteria forms. The forms contained a photocopy of a physician’s signature and became part of the patient files used to support Medicaid reimbursement claims.

The government’s complaint explained the purpose of the required assessment: determining the appropriate level of care under the state rules applicable at the time. It alleged that staff created the forms to make it appear that a physician had evaluated the patient, then used them to support reimbursement for the indicated level of care.

The admission included an assessment, but unqualified admissions staff performed it. The photocopied signature supplied the appearance of a physician’s involvement. A file could carry that appearance all the way into the paperwork supporting a Medicaid claim.

We look at who actually assessed the patient and how the signature reached the form. A completed form tells the billing side that an admission has supporting paperwork. A staff member who knows how it was completed may know something quite different about the clinical work behind it.

The Settlement Reached the Owner Personally

ACI agreed to pay $3 million, based on the government’s assessment of its ability to pay using financial information the company provided. Its primary owner and former CEO personally agreed to pay the same amount. The allocation designated $2.4 million for the United States, with the remainder going to New York.

The owner also agreed to give up ownership and control of ACI and voluntarily accepted exclusion from Medicaid and other federal healthcare programs for 15 years. The company agreed to implement procedures designed to make its patient transportation services comply with legal requirements.

The Southern District of New York’s Civil Frauds Unit handled the case. The announcement credited the Department of Health and Human Services’ Office of Inspector General, the New York Attorney General’s Medicaid Fraud Control Unit, and the New York State Office of Addiction Services and Supports with assisting.

What Evidence Does a Whistleblower Need?

In a case like ACI’s, the useful evidence connects how patients arrived, who was paid, who assessed them, and what supported the Medicaid claims. The case joins recruiting incentives, an employee’s referral lists, management’s response to reported inducements, and admissions forms bearing copied physician signatures.

Different workers can see different parts. A driver may know how recruitment targets affected pay. A payroll employee may know which job the company was paying someone to perform. An admissions worker or clinician may know who actually assessed a patient and how the physician’s signature appeared. Those perspectives can explain a discrepancy that a completed patient file or a job title conceals.

The management admissions are especially useful here. Information about what reached decision-makers, and how they responded, connects an employee’s account to choices inside the organization. We work with insiders to understand those connections and build the case around the conduct they know.

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

You Know What Was Behind the Admission

If you saw recruiting targets, a referral source on the payroll, or a copied physician signature supporting an admission, speak with our whistleblower experts. We build the case with you and bring in healthcare fraud whistleblower lawyers who understand addiction treatment referrals and Medicaid billing. We stay with you from the first conversation through building and pursuing your case.