Nova Psychiatric Services: Therapy Added to the Bill, Not Delivered to the Patient

In the Nova Psychiatric Services fraud case, Nova, Patriot Eldercare and their physician owner agreed to pay $1.4 million to resolve allegations of billing for psychotherapy and medication-management services clinicians did not perform. The Justice Department’s account describes contractors adding services to claims before submission, while employees repeatedly raised concerns with management. For a clinician or billing employee, the question is familiar and concrete: did the claim still describe the care you knew had occurred?

The U.S. Attorney’s Office for the District of Massachusetts announced the settlement on May 18, 2026. Nova Psychiatric Services and Patriot Eldercare, collectively also known as Prime Behavioral Health, had offices in Quincy and Weymouth, Massachusetts. Their founder and owner, a psychiatrist who served as president and director of both companies, joined the settlement. The Justice Department said the companies and owner admitted and accepted responsibility for certain facts underlying it.

The Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation, Boston Division, joined the U.S. Attorney’s Office in announcing the settlement.

Psychotherapy and Medication Management Billed to Medicare and Medicaid

The Nova settlement concerned claims to Medicare, Medicaid and the Massachusetts Group Insurance Commission for medication management and psychotherapy. The Justice Department’s account covered January 1, 2017 through May 18, 2023. It described billing for services behavioral health clinicians had not performed. The alleged false bills put taxpayers on the hook for care patients never received.

In outpatient psychiatry, the claim describes professional work: the service, the practitioner who furnished it, and the time or other requirements attached to that service. A patient can have a medication-management visit and receive psychotherapy during the same encounter. The psychotherapy portion has its own documentation and time requirements.

That distinction puts the clinician’s account of the visit at the center of the billing question. The treatment note describes the work. The submitted claim states what the insurer is being asked to pay for.

How Contractors Changed the Claims

According to the Justice Department’s account, Nova’s chief operating officer directed independent contractors, separate from the companies’ billing departments, to alter claims. They added billing codes for psychotherapy and medication-management services that Nova or Patriot clinicians had not performed. The changes occurred before submission to the government health insurance programs.

The contractor handoff matters: what left the clinician or billing team, what the contractors added, and what reached the insurer. A clinician’s accurate account of the visit can sit upstream of a false bill.

The same announcement describes a separate criminal case against the chief operating officer. He pleaded guilty to healthcare fraud charges concerning his direction of contractors with no billing or medical training to submit false claims on behalf of Nova and Patriot. The charges concerned some of the same billing covered by the civil settlement.

We have a hard time finding the clinical judgment in an arrangement where people without billing or medical training were directed to add clinical services to insurance claims. The extra care existed on the bill. The Justice Department’s account says the clinicians never performed it.

Employee Concerns Reached Management

According to the Justice Department, Nova and Patriot employees repeatedly raised concerns about the billing practices with the physician owner and the chief operating officer, but the companies and those executives made no changes to the practices.

The Justice Department’s account puts the objections directly in front of the psychiatrist who owned the clinics and the executive directing the changes. We see the absurdity: the people positioned to stop the billing heard about it repeatedly. The bills stayed the same.

For an insider, that is an important part of the story to explain to us: what you saw, who heard about it, and what happened to the billing afterward.

Why Added Psychotherapy Codes Matter

Psychotherapy add-on billing represents psychotherapy delivered alongside a separately identifiable evaluation-and-management service. The added code claims additional work that the patient must actually have received.

The Medicare contractor First Coast’s coding guidance effective January 1, 2025 calls for start and stop times or total psychotherapy time, excluding evaluation-and-management time. This later contractor guidance illustrates why the services are billed separately: the medication-management portion cannot supply the minutes claimed for psychotherapy. The article describes psychotherapy bands of 16 through 37 minutes and 38 through 52 minutes, with a longer category beginning at 53 minutes. These are minutes of psychotherapy, which makes the content of the encounter as important as its overall length.

The question is what happened during the visit. A claim can describe additional treatment beyond the work the clinician performed, and the person who saw the patient may recognize that mismatch immediately.

What Evidence Is Needed to Prove Fraud?

For claim changes like those described at Nova, we work with you to connect the care delivered with the codes submitted and the people who directed the changes. We examine the treatment account alongside the billing history, then connect any additions to the instructions and employee concerns surrounding them.

A clinician may know exactly which services were performed. A billing employee may recognize codes that appeared after the initial claim was prepared. Someone involved in operations may understand who directed those changes and how concerns reached management. Those are different views of the same process, and our work is to connect them into a specific account of the false claims.

The payer matters too. Nova’s announcement identifies government health care programs, and the civil settlement resolved False Claims Act allegations. Our assessment begins with your knowledge of the work inside the clinic.

How Much of a Settlement Does a Whistleblower Get?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. Whistleblowers brought a qui tam case whose claims were included in the Nova resolution. The announced whistleblower share was 18% of the settlement.

The Pattern in Other Psychiatric Billing Cases

Mindpath Care Centers North Carolina and former officers paid $1.9 million to the United States in a settlement announced in December 2025. The U.S. Attorney’s Office for the Eastern District of North Carolina alleged that psychotherapy and medication-management claims lacked documentation of separate, distinct psychotherapy, despite repeated employee concerns. The overlap with Nova is the combination of disputed psychotherapy billing and concerns raised inside the business. It makes what management heard part of the billing story.

American Psychiatric Centers, doing business as Comprehensive Psychiatric Services, agreed to a $2.75 million settlement announced in August 2025. The U.S. Attorney’s Office for the Northern District of California alleged that it used psychotherapy add-on codes 90833 and 90836 with evaluation-and-management visits when psychotherapy was absent or inadequately documented. The allegation focused on whether the additional psychotherapy service had been provided and documented.

The recurring question is what supports the added service. Nova adds a particularly concrete account of how claims changed hands and what happened when employees objected. The people who know the care and the billing process can explain what the final claim alone leaves hidden.

You Know What Happened During the Visit

If you saw services added to claims after a medication visit, or raised concerns that management left unanswered, speak with our whistleblower experts about the services billed but never given. We work with you to build your strongest behavioral health whistleblower case around the care, the claim changes and the people directing them, and bring in behavioral health fraud whistleblower lawyers who understand psychiatric billing. You have a partner beside you from the first conversation through the case.