Connecticut Counseling Centers: The Medicaid Overpayment Allegations

Connecticut Counseling Centers agreed to pay more than $295,000 to settle allegations that it caused Connecticut Medicaid overpayments.

The substance-abuse treatment provider entered into a civil agreement with the federal and state governments. The U.S. Attorney’s Office for the District of Connecticut announced the settlement on May 5, 2020.

A Weekly Rate That Already Included Testing

The full settlement announcement explains the Connecticut Counseling Centers billing dispute. Connecticut’s 2013 regulation included on-site drug testing and monitoring in the weekly Medicaid methadone-treatment payment. A September 3, 2014 provider bulletin repeated that rule. A February 1, 2015 audit protocol said the clinic’s payment would be reduced by the laboratory cost if Medicaid also paid another laboratory for testing within the same week.

An audit found that Connecticut Counseling Centers and an independent laboratory had both billed for testing performed by the laboratory. A January 2016 audit report warned the centers about continued noncompliance. The government alleged that the centers continued sending samples to an outside laboratory, leaving Medicaid paying twice: through the clinic’s bundled rate and through the outside laboratory’s claim.

The civil settlement covered conduct from January 18 through December 31, 2016. The account links an identified payment rule, an audit warning and the referrals that continued afterward.

A Separate Laboratory Case: Paying Twice for Drug Testing

In a separate Medicare case, the Department of Justice alleged that Pacific Toxicology Laboratories billed for urine drug testing already covered by opioid treatment program payments.

What Your Knowledge of the Billing Can Show

Ordering a test, performing it and billing for it can put different businesses into the same payment chain. Clinic and laboratory employees may see different sides of the same transaction.

If you know that a treatment payment already covered testing and that an outside laboratory billed the government again, we want to understand the arrangement you saw. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know the Treatment and the Bills

If you work in treatment or laboratory billing and can explain where the payment went wrong, talk with our whistleblower experts. We build the case with you and bring in laboratory fraud whistleblower lawyers who understand health care payment arrangements. We stay beside you as your knowledge of the treatment and the bills becomes the foundation of the case.