Massachusetts Mental Health Centers Submitted False Claims According to Suit
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On January 5, 2018, the state of Massachusetts lodged a False Claims Act (FCA) suit in federal court against the operators of a number of mental health centers. In the suit, it is alleged that they improperly billed the state Medicaid program for services provided by unlicensed, unqualified and unsupervised employees.
The complaint seeks to recover MassHealth’s payments to South Bay Mental Health Center Inc. and its subsequent owners for claims they knew were false. Allegedly, they billed for services provided by unlicensed social workers who weren’t properly supervised even though it violated statutory and regulatory requirements.
The complaint alleges that from at least August 2009 to the present, defendant South Bay failed to comply with applicable statutes and regulations regarding licensure and supervision requirements for staff. Additionally, the centers allegedly employ a number of staff therapists and clinic directors who aren’t licensed as social workers or mental health counselors. Unlicensed social workers can provide mental health services to MassHealth members as long as they are supervised by an independently licensed clinical social worker. This was not the case for the vast majority of South Bay’s unlicensed therapists, the complaint alleges.
The filing continues, “As a result of the noncompliance, from at least August 2009 to the present, defendant South Bay, either with actual knowledge or deliberate ignorance of or reckless disregard for the truth, submitted or caused to be submitted false claims for services to the MassHealth program in violation of [the Massachusetts False Claims Act].”
According to the suit, South Bay could have ensured that the staff at each center was properly credentialed during the hiring process and made sure that workers who needed supervision had it, but the company declined to do so.
The suit was originally brought forth in 2015 by relator Christine Martino-Fleming, who served as coordinator of staff development and training at South Bay. South Bay fired her in September 2014 after she raised concerns about the company’s regulatory violations, according to court documents.
Here is the complaint in full for Christine Martino-Fleming v South Bay Mental Health Centers, et al.
There have been an increasing number of Medicare and Medicaid audits being initiated against psychologists and other mental health professionals.
To gain more insight on these types of audits click the link above to read one of my prior blogs.
Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.
Attorneys with The Health Law Firm represent physicians, nurses and other health professionals who desire to file a False Claims Act (whistle blower or qui tam) case. This case just shows that even physicians can and should bring such claims and be rewarded for their whistle blowing activities. However, the attorneys of The Health Law Firm also defend physicians, medical groups and health facilities who have been sued in False Claims Act (whistle blower or qui tam) cases or have had administrative or civil complaints filed against them to recover civil monetary penalties. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistle blower cases, as well.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Posses, Shayna. “Mental Health Centers Submitted False Claims, Mass. Says.” Law360. (January 5, 2017). Web.
Foley, Elizabeth. “Supreme Court to Decide What Qualifies as “False” under the False Claims Act.” Barrett and Singal Law Firm. (January 8, 2018). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
KeyWords: False Claims Act case, legal representation for whistle blower suits, legal representation of plaintiffs in whistle blower cases, legal representation of defendants in whistle blower cases, legal representation in complex health care litigation cases attorney lawyer, legal representation in federal and state courts attorney lawyer, whistle blower defense attorney, legal representation in qui tam lawsuits, qui tam defense attorney, psychiatrist and psychologist defense attorney, medical group defense attorney, psychiatrist and psychologist defense lawyer, psychiatrist and psychologist defense lawyer, psychiatrist and psychologist defense counsel, psychiatrist and psychologist defense counsel, Board of Medicine and Psychology license defense attorney, Board of Medicine and Psychology license defense lawyer, Board of Medicine and Psychology license defense counsel, FCA defense attorney, legal representation for Medicare false claims, legal representation for false billing, Medicare fraud defense attorney, legal representation for Medicare fraud, legal representation for Medicare audit, complex health care litigation defense attorney, health care fraud defense attorney, complex health care litigation defense lawyer, legal representation for health care professionals, health law defense attorney, The Health Law Firm attorney reviews, reviews of The Health Law Firm, whistle blower plaintiff attorney, health care professionals defense counsel, health care professional defense lawyer, health care professional defense counsel, whistle blower defense attorney, whistle blower defense lawyer, mental health facilities defense counsel, mental health facilities defense attorney, mental health facilities defense lawyer, legal representation for whistle blower suits, legal representation for qui tam suits, qui tam relator attorney, qui tam relator lawyer, qui tam relator legal counsel, mental health counselor and social worker defense attorney, mental health counselor and social worker defense lawyer, mental health counselor and social worker defense counsel.
The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., a Florida professional service corporation, since 1999, and is also a registered service mark.
Copyright © 2018 The Health Law Firm. All rights reserved