Roanoke Comprehensive Treatment Center: Counseling by Staff Without Required Addiction Credentials

In the Roanoke Comprehensive Treatment Center fraud case, Virginia Treatment Center LLC agreed to pay $348,934 to resolve allegations under the False Claims Act that it billed Virginia Medicaid for counseling by staff who lacked required addiction-treatment credentials. The Justice Department announced the settlement on July 19, 2022. The government alleged that the bills represented those workers as properly credentialed professionals. For someone inside a treatment center, that puts the counseling room and the billing office in the same story: who did the work, and what did Medicaid pay for?

What the Roanoke Medicaid Case Was About

The government alleged that Roanoke Comprehensive Treatment Center billed Virginia Medicaid for counseling by uncredentialed personnel from January 1, 2018 through December 31, 2020. The Justice Department said the center had to conduct face-to-face counseling sessions, but billed for work by people without the credentials as though qualified addiction professionals had provided it.

That is a specific representation about the person delivering treatment. A patient can attend a session while the claim misrepresents the counselor’s qualifications.

The distinction matters in opioid treatment, where medication and counseling can sit inside the same healthcare business. Delivering medication does not answer whether a counseling claim accurately describes the professional who provided that service. The Roanoke allegation concerned that counseling representation.

We see nothing minor about the alleged substitution: Medicaid was paying for qualified care, and patients were the people sitting across from the workers the center assigned to provide it.

Who Virginia Treatment Center Was

Virginia Treatment Center LLC did business as Roanoke Comprehensive Treatment Center in Roanoke, Virginia. The Justice Department’s announcement identified the center as an Acadia Healthcare subsidiary providing outpatient treatment, including medication-assisted treatment for adults with opioid addiction.

The credentials of the person conducting counseling matter even when the bill comes from the treatment business.

Why the Counselor’s Credentials Matter

In the Roanoke case, the government alleged that Medicaid received bills representing credentialed addiction counseling when the workers lacked the required credentials. The question is who held which credential on the day of the session.

A Parallel at New Life Lodge

At New Life Lodge in Tennessee, the whistleblower complaint alleged that CRC Health Corporation represented counseling as care provided by licensed counselors even when unlicensed technicians performed it.

Who Investigated the Roanoke Case?

An assistant U.S. attorney investigated the Roanoke matter. The announcement credited a coordinated effort by the U.S. Attorney’s Office for the Western District of Virginia, the U.S. Department of Health and Human Services, and the Virginia Attorney General’s Medicaid Fraud Control Unit.

The Department of Health and Human Services Office of Inspector General also put the patient beside the payer in explaining the issue: billing for services as though credentialed professionals performed them can mislead both. That is why this health care allegation reaches beyond the billing department. The qualification represented in a claim concerns the care patients were supposed to receive.

What Evidence Is Needed to Prove Fraud?

For a counseling-credential allegation, the evidence needs to connect the claim and service date to the actual worker, the counseling delivered and the qualifications represented. We examine those connections with the insider who understands how the center operated.

Staff assignments and treatment records can identify who performed the work. Credential records concern that person’s qualifications. Billing records show what the organization represented to Medicaid. Putting those accounts beside each other gives a concrete meaning to a concern that might otherwise be described simply as a staffing problem.

The payer belongs in that comparison too. Medicaid qualifications and payment terms involve state rules and contracts.

For a counselor, the useful knowledge may be who delivered the sessions. For a billing employee, it may be how the center described those sessions when seeking payment. We work with that firsthand view to understand the alleged mismatch and bring in whistleblower lawyers who know addiction-treatment billing. The people closest to the work can explain what a billing description leaves out.

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. Speak to one of our whistleblower experts about the counseling you saw billed.

You Know Who Delivered the Counseling

If you know the staff behind counseling claims that promised different qualifications, talk with our whistleblower experts about what you saw. We build the case with you, match it with addiction-treatment fraud whistleblower lawyers and stay beside you as your knowledge becomes the basis for pursuing a recovery.