Mental health services provider enters into $4M FCA settlement

A provider of in-home mental health services and two of its leaders agreed to pay a total of $4.5 million to settle allegations that they violated the federal False Claims Act (FCA) and the Minnesota False Claims Act by billing Medicaid for services that violated clinical supervision requirements. Under the agreement, Complementary Support Services (CSS) and related entities will pay $4 million, its president will pay $400,000, and an executive will pay $120,000.

According to Acting U.S. Attorney Gregory G. Brooker and Minnesota Attorney General Lori Swanson, CSS provided in-home mental health services to children and adults through two Medicaid programs that restrict reimbursement to time spent providing face-to-face services with the patient and prohibit reimbursement for a therapist’s time completing paperwork. Both programs also require a licensed therapist such as a social worker or psychologist to clinically supervise patient care to ensure that the services are appropriate and medically necessary.

Between 2007 and 2016, however, CSS failed to submit claims that reflected signature by licensed professionals serving as clinical supervisors. Instead, CSS’ president “batch signed” progress notes that formed the basis for billing Medicaid. In addition, CSS employees routinely added an extra billable unit for paperwork time for each client visit.

Local news reported that this case reflected a longstanding gap in Minnesota’s oversight of mental health services because CSS, like 200 other agencies, was unlicensed and not subject to routine regulatory oversight. In the wake of these allegations, the state began reviewing its oversight of mental health agencies.

As a part of the settlement, CSS is permanently excluded from participating in federal and state health care programs. The president agreed to an exclusion of at least eight years, and the executive agreed to an exclusion of at least five years.