MM Curator summary
[MM Curator Summary]: The BH provider billed for expensive family therapy sessions when really all they were doing was updating prescriptions.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
ATLANTA, GA – Attorney General Chris Carr today announced that Atlanta Behavioral Medicine, Inc., an Atlanta-based psychotherapy services provider, has agreed to pay $650,000 to resolve allegations that it improperly billed Georgia Medicaid for therapy services that never occurred.
“Our Medicaid Fraud Division works diligently to uphold the integrity of Georgia’s Medicaid program and protect taxpayer dollars no matter the amount,” said Carr. “This includes pursuing providers who violate the public’s trust by abusing a system meant to care for our most vulnerable. We will not hesitate to hold those who engage in this type of behavior accountable for their actions.”
An investigation by the Georgia Attorney General’s Medicaid Fraud Division uncovered evidence that between 2016 and 2020, Atlanta Behavioral Medicine improperly billed the Medicaid program for family psychotherapy sessions on a number of occasions when its patients only received basic medication management. According to accepted coding standards in the industry, these visits failed to qualify as therapy sessions, which resulted in Atlanta Behavioral Medicine receiving overpayments for the actual service rendered.
This case was investigated by the Georgia Medicaid Fraud Division, including Investigator Paris Patrick, former Investigative Auditor Jimmy Oho and Chief Nurse Investigator Judy Cooper. The civil settlement was reached by Assistant Attorney General Jessica Hall.
When approached concerning the State’s allegations, Atlanta Behavioral Medicine cooperated to reach an efficient resolution to the matter. As a part of the settlement, the defendants denied the factual allegations. The claims resolved by this settlement are allegations only, and there has been no determination of liability.
About the Medicaid Fraud Division
Since November 2016, the Georgia Attorney General’s Medicaid Fraud Division has obtained civil recoveries totaling more than $68 million. Over this same time period, the Medicaid Fraud Division has prosecuted more than 60 people for Medicaid fraud and the abuse, neglect and exploitation of older adults, resulting in $17 million in restitution orders in criminal matters.
The Georgia Medicaid Fraud Division
receives 75
percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $5,581,864
for federal fiscal year (FY) 2022. The remaining 25
percent, totaling $1,395,464
for FY 2022, is funded by the State of Georgia.
Clipped from: https://law.georgia.gov/press-releases/2022-08-10/carr-medicaid-fraud-division-secures-650000-settlement-atlanta-behavioral