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Case Number: 2:16-cv-01039-NJ
Judge: Nancy Joseph
Court: United States District Court for the Eastern District of Wisconsin (Milwaukee County)
Plaintiff's Attorney: United States Attorney’s Office
Description: Milwaukee, WI: Civil litigation false claims act violation lawyers represented Bell Therapy, Inc., and its parent company, Phoenix Care Systems, Inc., agreed to pay $390,080 to resolve allegations that they billed for services at the incorrect rates and billed for services not properly reimbursed, causing false claims for those services to be submitted to the Medicaid Program.
Bell Therapy operated two facilities in the Milwaukee area licensed to administer Community Support Programs (CSPs). CSPs provide services to mentally ill individuals in Wisconsin and are supported by state and federal Medicaid funds. The settlement resolves allegations that Bell Therapy fraudulently submitted claims for services rendered by providers without the requisite credentials or qualifications and/or at an incorrect billing rate as well as claims for group services billed as individual services. It also resolves allegations that Bell Therapy providers improperly billed for non-face-to-face activities.
“The U.S. Attorney’s Office prioritizes efforts to stop healthcare fraud and seeks to protect health care program beneficiaries and the American taxpayers,” said Acting United States Richard Frohling. “This settlement demonstrates our continuing efforts to combat violations of the False Claims Act.”
“Medical providers must ensure that the services they provide and bill for are conducted by personnel with appropriate credentials and qualifications and accurately reflect the service that is actually provided,” said Lamont Pugh III, U.S. Department of Health & Human Services, Office of Inspector General – Chicago Region. “The OIG will continue to identify and investigate allegations of potential fraudulent billing to the Medicaid program in order to protect the health and safety of patients and vital taxpayer dollars.”
The settlement resolves a lawsuit filed under the whistleblower provision of the False Claims Act, which permits private parties to file suit on behalf of the United States. Accordingly, the whistleblower will receive a share of the settlement proceeds.
Assistant United States Attorney Lisa Yun represented the government in this matter. The U.S. Department of Health and Human Services Office of Inspector General assisted in the investigation. The claims resolved by the settlement are allegations only; Bell Therapy and Phoenix Care Systems do not admit liability for the allegations.
Outcome: Settled for $390,080.00.