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Date: 05-09-2022
Case Style:
Case Number:
Judge: Non
Court: United States District Court for the Southern District of California (San Diego County)
Plaintiff's Attorney: United States Attorney’s Office
Defendant's Attorney: Not Available
Description: San Diego, California: Prism Behavioral Solutions provides treatment to children diagnosed with autism and other related disorders through therapy called Applied Behavioral Analysis. Prism Behavioral Solutions maintains a corporate address in Woodland Hills, California, and provides medical services to patients in Southern California. The United States and the State of California alleged that Prism Behavioral Solutions violated the federal False Claims Act and the California False Claims Act by knowingly submitting false claims to Medi-Cal for medical services that Prism Behavioral Solutions did not perform from September 2016 through December 2019. According to a whistleblower’s complaint, this included Prism Behavioral Solutions billing Medi-Cal for cancelled appointments.
“Billing government health care programs for services not rendered negatively impacts the entire health care system,” said U.S. Attorney Randy S. Grossman. “This settlement shows our continuing commitment to protect the integrity of government health care programs and other taxpayer-funded programs. We commend the whistleblower in this case for coming forward, and the team of federal and state agency partners and Assistant U.S. Attorneys for their work on this case.”
This settlement resolves the allegations in a former Prism Behavioral Solutions employee’s whistleblower lawsuit filed under the qui tam provisions of the False Claims Act, which permit private individuals to sue for false claims on behalf of the government and to share in a recovery. The civil lawsuit was filed in the Southern District of California and is captioned United States and the State of California, ex rel. Mason v. Prism Autism Foundation, 19-CV-0043-W (BLM). As part of this settlement, the whistleblower will receive $130,000.
“Prism had the important responsibility of supporting and caring for children and young adults with autism spectrum disorders,” said Attorney General Rob Bonta. “Instead of fulfilling its obligation to the families under its care, Prism is alleged to have filed false claims and misused state taxpayer money. These allegations are shameful and these families deserved respect and dignity, not to be used to cheat state resources. I am grateful to the U.S. Attorney’s Office for their involvement in this investigation, which helped bring justice to these families and California taxpayers. My office will continue to hold accountable bad actors who hurt the health and well-being of Californians.”
The resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
This matter was handled by Assistant U.S. Attorney Dylan M. Aste of the U.S. Attorney’s Office for the Southern District of California; the Office of Inspector General for the U.S. Department of Health and Human Services; and the California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse.
The claims resolved by this settlement are allegations only and there has been no determination of liability.
Outcome: Prism Behavioral Solutions paid $650,000 to resolve allegations that it billed the state’s Medicaid Program, known as Medi-Cal, for services to autistic children without actually providing care to the children, according to a settlement agreement signed by Prism Behavioral Solutions, the United States, and the State of California.
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