K-Assist: Unlicensed Therapy Allegedly Billed as Licensed Care

In the K-Assist fraud case, the practice and its owner paid $234,064 to resolve allegations that they billed Medicaid for psychotherapy performed by unlicensed workers as though licensed providers had delivered it. For someone who knew the people making the home visits, the allegation goes straight to the difference between the therapist a patient saw and the provider Medicaid was told had done the work.

K-Assist was a private behavioral health practice providing in-home services in the greater New Haven area. The Justice Department’s April 18, 2023 announcement described the practice as enrolled as a Behavioral Health Clinician Group in the Connecticut Medical Assistance Program, which includes Medicaid. Its owner was enrolled as a Professional Counselor. The government alleged false psychotherapy claims for conduct from February 1, 2018 through August 1, 2019.

The Therapist Behind the Medicaid Claim

The alleged billing mismatch concerned the qualification of the person who actually provided psychotherapy. The government said K-Assist and its owner represented that licensed providers had rendered services that unlicensed individuals performed.

K-Assist had a group enrollment, and its owner had a counselor enrollment. Neither tells an insider who walked into a patient’s home. The government’s allegation concerned that person: the worker who delivered the psychotherapy, rather than the qualification attached to the bill. An insider who knows who attended the home visit can supply a view of the encounter that the claim’s provider information alone cannot give.

We see a basic breach of trust in the allegation: a patient’s therapy was represented to Medicaid as the work of someone with a qualification the actual worker lacked. The credential did the billing work. The person holding it allegedly did not do the therapy.

The Civil Payment and the Owner’s State Case

K-Assist and its owner entered a civil settlement with the federal and state governments to resolve allegations under their False Claims Acts. The payment reimbursed Medicaid for the alleged conduct.

The case grew out of a broader investigation into behavioral health services. The Department of Health and Human Services Office of Inspector General, the Medicaid Fraud Control Unit of the Chief State’s Attorney’s Office and the Connecticut Office of the Attorney General jointly conducted that investigation. The Connecticut Department of Social Services supported it.

The same government announcement separately reported that the owner entered a no-contest plea to health insurance fraud in a state criminal proceeding.

Another Practice’s Alleged Use of Someone Else’s Credentials

The whistleblower’s complaint against Texas Behavioral Health alleged that the practice billed a chemical dependency intern’s services under a licensed counselor’s identity, another alleged mismatch between who delivered care and whose credentials appeared on the claim.

What Someone Inside the Practice Can Explain

Someone who knows both the home visits and the billing can explain where the two accounts diverge. The K-Assist allegation turns on who performed psychotherapy. That distinction shows why an insider’s understanding of staffing can matter as much as familiarity with claims.

For a clinician, that understanding begins with the work assigned to colleagues and the qualifications they held. For a billing employee, it begins with the provider attached to a service. For someone responsible for enrollment, it begins with the difference between a worker’s credentials and the practice’s relationship with the payer. These are different views of the same encounter, and we work with the person who can explain how they fit.

Our focus is the connection between the care, the representation on the claim and the decisions inside the practice. You may recognize that connection from ordinary work long before you have a name for the fraud mechanism. That is a useful place to begin a conversation with our whistleblower experts.

A Whistleblower’s Share of the Recovery

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. If you know how a behavioral health practice represented its workers to Medicaid, we can assess the case with you and bring in whistleblower lawyers who understand psychotherapy billing and provider qualifications.

You Know Who Delivered the Therapy

If the provider on the bill was not the person your practice sent to the patient, speak to one of our Whistleblower Experts about who really delivered the therapy. We bring the billing knowledge and behavioral health whistleblower lawyers to build your strongest case, and stay beside you throughout.