Complementary Support Services: An Extra Unit for the Paperwork

In the Complementary Support Services fraud case, the provider and two leaders agreed to $4,520,000 in civil settlements over allegations that they billed Medicaid for paperwork as face-to-face treatment and for care without required clinical supervision. The government alleged that employees added paperwork units to visits and a leader signed progress notes in batches instead of providing the required clinical review.

The Justice Department announced the settlements on May 30, 2017. A whistleblower brought the case under the False Claims Act, and the settlements resolved federal and Minnesota false-claims allegations. Complementary Support Services provided in-home mental health services to children and adults, paid for through Medicaid. Federal and Minnesota taxpayers funded that care.

The Rehabilitation Services Behind the Claims

Complementary Support Services delivered services through Adult Rehabilitative Mental Health Services and Children’s Therapeutic Services and Supports. In its account of the case, the Justice Department described both programs as paying for face-to-face services with the patient and prohibiting reimbursement for a therapist’s paperwork time.

The same account explains the clinical safeguard: a licensed therapist, such as a social worker or psychologist, had to supervise patient care so that the services were appropriate and medically necessary.

Medicaid rehabilitation aims to reduce disability and restore function. In these programs, the work described in a note had to support the face-to-face service claimed. The alleged extra unit turned time spent writing about a visit into more time treating the patient.

An Extra Face-to-Face Unit for Paperwork

The government alleged that Complementary Support Services employees routinely added an extra billable unit for paperwork to each client visit, at the direction of the provider’s leaders. They represented that additional unit as face-to-face time with the patient.

According to the Justice Department, the practice began in January 2007 and generated thousands of additional units paid by Medicaid. The alleged instruction made paperwork time billable by changing how it appeared on the claim. According to that allegation, Medicaid paid for patient contact while the employee completed a record.

The extra unit is what makes this case recognizable to someone who worked in scheduling, treatment or billing. An employee could know what happened during a visit and why the bill included another unit. The government’s account connects the addition to instructions from leadership, giving the billing practice a source inside the organization.

That is the difference an insider can explain: what the extra time was spent doing, how it reached the claim and who directed employees to describe it that way.

Batch-Signed Notes and Missing Clinical Supervision

The supervision allegation concerned claims submitted from January 1, 2007 through April 8, 2016. The government alleged that Complementary Support Services knowingly billed Medicaid while failing to meet the programs’ clinical-supervision requirements.

During most or all of that period, the government alleged, the provider did not engage licensed professionals who agreed to accept full professional responsibility for the actions and decisions of the unlicensed workers delivering care. One of its leaders instead signed progress notes in batches. Those notes formed the basis for Medicaid billing.

The release described more than 85,000 claims submitted since the beginning of the alleged period, covering hundreds of clients served by unlicensed staff across multiple Minnesota regions. The government’s allegation was that the client files had not received the required review and supervision.

Here, the signature was supposed to reflect clinical responsibility for another person’s work. The allegation was that Complementary Support Services supplied signatures without the required supervisory relationship behind them. Taxpayers were supposed to fund supervised care. According to the government, patients instead received care from workers whose decisions no licensed professional had agreed to take responsibility for.

The paperwork and supervision allegations reached different parts of the same claim. One concerned the additional time billed as patient contact. The other concerned responsibility for the care delivered by the direct-service worker.

The Civil Settlement and the Money Sent to Wisconsin

Complementary Support Services agreed to pay $4 million. The leader accused of signing notes in batches agreed to pay $400,000, and the other leader agreed to pay $120,000.

The government also reported that the batch-signing leader had transferred $2 million in Medicaid funds from Complementary Support Services to a nonprofit she started in Wisconsin. Money meant for Minnesota patients had gone to another organization the same leader had started.

Under a separate civil forfeiture agreement, the government would retain $1.75 million of the alleged fraud proceeds.

Including that separate agreement, the Justice Department described the government’s total recovery as $6.27 million.

Program Exclusions and Continued Patient Care

Complementary Support Services agreed to permanent exclusion from federal and state health care programs, and its patients transferred to other providers of the same adult and children’s services.

Both leaders also agreed to years of exclusion from healthcare programs as part of their civil settlements.

The Same Billing Mismatch in Other Behavioral Health Cases

Other behavioral health cases show how administrative work, staff identity and treatment records can diverge from the service a claim describes.

Early Autism Project and Administrative Work Billed as Treatment

In the Early Autism Project settlement, the government alleged that therapy hours were reserved for regional administrative positions even though those employees had not worked with the child whose care was billed. The allegations concerned inflated applied behavior analysis time submitted to TRICARE and South Carolina Medicaid.

The parallel to Complementary Support Services is direct: both cases alleged that administrative work became a claim for patient-specific treatment. At CSS, the alleged addition was paperwork attached to a visit. At Early Autism Project, the government alleged that time allocated to administrative positions was charged as work with a child.

LXE Counseling and Face-to-Face Claims From Elsewhere

The government obtained a judgment against LXE Counseling in a case involving unqualified providers, altered dates, times and codes, and purported face-to-face sessions while the owner was traveling or attending other events. The government’s claims also concerned rehabilitation furnished without the required accompanying psychotherapy.

That case connected the claimed service to the person, location and surrounding treatment. The allegations against Complementary Support Services likewise required looking past the face-to-face label to the work and supervision behind it.

Community Mental Health Affiliates and Unsupported Rehabilitation Hours

In the Community Mental Health Affiliates settlement, the government alleged that monthly rehabilitation payments lacked records establishing at least 40 covered service hours per month for affected residents. The allegations concerned Connecticut payments from January 2015 through December 2019.

Here the disputed support was for a monthly service requirement. The paperwork allegation against Complementary Support Services concerned an extra unit attached to an individual visit. Each case turns on the work that the particular payment was supposed to purchase.

What Evidence Is Needed to Prove Fraud?

We help you connect rehabilitation claims to the service delivered, the person who delivered it, the treatment note and the supervision behind it. In the allegations against Complementary Support Services, the extra-unit instruction and the batch-signing practice connected individual records to decisions made across the business.

We work with insiders who understand those decisions: what a visit involved, how time became billable units and who took responsibility for the clinical work. Your knowledge of that process can explain a discrepancy that a claim total or a signed note leaves hidden.

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

You Know How the Visit Became a Bill

If you saw paperwork turned into patient-contact units or signatures standing in for clinical supervision, tell our whistleblower experts how the billing worked. We develop the case around your knowledge of the operation, bring in behavioral health fraud whistleblower lawyers who understand Medicaid rehabilitation claims, and stay with you as the case moves forward.