Families United Services: ACT and Core Services Allegedly Billed Without Delivery

In the Families United Services fraud case, the company and its owner agreed to pay $645,000 to resolve allegations that they billed Georgia Medicaid for behavioral health services they never provided. The services at issue were Assertive Community Treatment, known as ACT, and Core. For an employee who knows the patient contacts, the schedules or the billing, the question is concrete: did the care on the claim happen?

What the Government Said Was Billed

The government alleged that Families United Services and its owner caused false claims for services never provided between October 1, 2010 and June 10, 2012. The company was a Georgia corporation enrolled with the Georgia Department of Community Health to provide behavioral health services. It served Medicaid members through programs operated by the Georgia Department of Behavioral Health and Developmental Disabilities.

We see the wrong plainly here: money intended for people who need mental health treatment becomes revenue for treatment the government says never happened.

What ACT and Core Services Meant in Georgia

The Justice Department’s announcement described Assertive Community Treatment as a recovery-focused, high-intensity service delivered in the community for adults with severe and persistent mental illness. Core covered a comprehensive range of outpatient and out-of-center mental health services for people of all ages.

In a behavioral healthcare operation, a billing employee may see the service dates and units submitted to Medicaid. A treating worker may know the contacts that actually occurred. A supervisor may know the staffing and care records behind both. We connect those accounts to understand how work in the community became a claim for payment.

In VNS Health’s New York ACT case, the company admitted receiving full monthly payment when documented contacts supported only partial payment; the government alleged that Families United Services billed Georgia Medicaid for care never provided.

Who Investigated and What the Settlement Required

The Georgia Medicaid Fraud Control Unit began investigating Families United Services after a referral from the Georgia Department of Community Health’s Program Integrity Section. The unit investigated the case with the U.S. Attorney’s Office for the Northern District of Georgia and the U.S. Department of Health and Human Services Office of Inspector General.

The Justice Department announced the civil settlement on February 6, 2019. Alongside the payment agreement, the company and its owner agreed to exclusion from federal health care programs for five years. The announcement explained that the exclusion barred those programs from paying for services they provided, including through an employer.

What an Insider Can Add to a Medicaid Billing Case

Billing and clinical staff each see part of the picture. Our work is to bring that operational knowledge and the payment records together. We work with the person who can explain the difference from inside the business.

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

You Know Whether the Care Happened

If you know how ACT or Core claims came to describe care nobody delivered, speak to one of our whistleblower experts. We build your strongest Medicaid whistleblower case around your knowledge of the operation and bring in Medicaid fraud whistleblower lawyers who understand behavioral health billing. We stay beside you throughout the case.