By: Najla Alexander
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An opioid abuse treatment facility in Camden will pay $3.15 million to resolve criminal and civil claims that it caused kickbacks, obstructed a federal audit, and fraudulently billed Medicaid, Attorney for the United States Vikas Khanna reported today.
According to authorities, Camden Treatment Associates LLC (CTA) agreed to pay $1.5 million in criminal penalties to resolve allegations that it violated the federal Anti-Kickback Statute and obstructed a Medicaid audit.
As part of the resolution, a criminal information was filed on December 2 in Camden federal court, charging CTA with this conduct. Authorities say that CTA entered into a three-year deferred prosecution agreement (DPA) that requires it to abide by certain measures to avoid conviction.
Officials say CTA also entered into a civil settlement agreement to pay $1.65 million to the United States to resolve claims that it violated the federal False Claims Act by submitting fraudulent claims to Medicaid.
According to CTA’s admissions in the DPA:
Between 2009 and 2015, CTA and a second company were owned and managed by related parties.
Authorities say CTA had a kickback relationship with the second company in which CTA ordered all of its methadone mixing services from the second company and paid it more than $172,800 for those services.
This arrangement resulted in kickbacks being paid because the second company paid the profits it made on CTA’s orders of methadone mixing to the related parties who owned and managed both companies, officials reported.
As a result, CTA was induced to order more services from the second company and to have CTA patients receive treatment using methadone mixed only by that company. CTA received more than $2.78 million from Medicaid for methadone administration services, according to officials.
In a separate criminal scheme, CTA obstructed a Medicaid contractor’s 2016 audit of CTA’s claims for payment. CTA submitted falsified materials to the auditor purporting to justify its claims to Medicaid.
Specifically, CTA added patient and counselor signatures to patient files, altered names of counselors listed as providing services, added credentials for staff listed as performing services, added sign-off dates for services, and, in some instances, submitted entire patient notes to files to justify services rendered. According to officials, the metadata from CTA’s electronic patient software program revealed that CTA employed these fraudulent means.
Authorities say the settlement resolves the civil allegations that CTA submitted false claims to Medicaid stemming from the kickback relationship with the methadone mixing company described above.
The settlement further resolves allegations that between 2013 and 2016, CTA failed to comply with certainspecificl and state regulations governing substance abuse treatment facilities, officials said.
Specifically, CTA allegedly failed to maintain proper supervision and staffing at its facility.
Officials say, instead, CTA typically used non-credentialed “counselor interns” to perform services at the facility and did not have sufficient licensed staff to properly supervise the interns, CTA’s claims submitted to Medicaid for payment, which were contingent on CTA’s certified compliance with these regulations, were false.”
The claims settled by this agreement are allegations only, and there has been no determination of liability, officials say.
As part of the DPA, CTA is required to adopt several compliance measures, including:
• Have an effective compliance program, including enhanced compliance policies and annual compliance training regarding federal health care laws.
• Retain an independent healthcare compliance consulting firm specializing in substance abuse disorder facilities to review its compliance program and make improvement recommendations comprehensively.
• Create an independent board of advisors to oversee company compliance relating to federal healthcare laws.
• Have a chief compliance officer oversee compliance-related functions at the company.
• Annually certify that its compliance program is effective.
• Provide written reports to the United States every six months over three years, detailing its progress in developing and enhancing its compliance program.