Mental health has been an area of scrutiny by federal law enforcement due to fraud and kickbacks in the provision of services to patients located in nursing homes, residential facilities and even in home. Psychiatrists, psychologists and other non psychiatric health care providers have had their billing and treatment practices questioned because of questionable billing of Medicare and Medicaid. If you have evidence of a violation of the False Claims Act, our whistleblower attorneys can help you report your evidence to the Justice Department and the Center for Medicare and Medicaid Services. Call 1-800-590-4116 or use our contact from to receive a free, confidential initial consultation.
Medicaid is the single largest payer for mental health services in the United States. Medicaid patients have higher rates of mental health and substance abuse disorders. Moreover, because of the low reimbursement levels for behavioral therapy in this government programs, many therapy providers won’t take patients with Medicaid.
Medicare Part B covers mental health services and visits with psychiatrists, clinical psychologists, nurse practitioners, physician assistants and other approved providers. These outpatient services include one depression screening per year, psychiatric evaluation, medication management, family counseling incident to mental health treatment and other approved services
A former Inspector general for the Department of Heath and Human Services said that many fraud investigators believe psychiatrists and psychologists have the worst fraud record in health care and that the problem has stretched back decades. Professionals working in a community mental health center offering a partial psychiatric hospital program may also be more likely to encounter fraud.
The False Claims Act
One of the primary tools of the Federal and State Governments to fight health care fraud is the False Claims Act. It authorizes whistleblowers to file a lawsuit which informs the government of the fraud and compensates them with 15 to 30 percent of the government’s recovery. More than half of the states have adopted versions of the False Claims Act which compensate whistleblowers for the state portion of Medicaid funds lost due to fraud.
Possible violations of the FCA by mental health professionals or service providers may include:
Services Not Provided or Double-Billed
Providers are engaged in fraud when they are billing Medicare or Medicaid for services they are not performing. It is not permitted to pad claims with extra hours.
Upcoding happens when a service is provided and the government is billed as if it was a service with a higher authorized reimbursement. For example, it is a violation of the FCA to bill group therapy as if multiple individual services have been performed.
Services Not Medically Necessary
Behavioral health services are not warranted in all situations. Sometimes, a patient is unlikely to benefit from the therapy. If a provider is engaged in therapy in order to generate a fee and bill their insurance rather than because it is medically justified, the provider is violating the False Claims Act when billing Medicare or Medicaid for those unnecessary services.
Unlicensed Employees and Unsupervised Services
The FCA is violated when a provider bills for services provided by an unlicensed practitioner without proper supervision.
Providers are engaged in fraud when they order unnecessary prescriptions of narcotics or psychotropic drugs for mental health patients with Medicare or Medicaid and the patient or provider fills the order.
Mental health professionals may resort to the payment of patient recruiters or assisted living facility owners for referrals. These improper payments can be the subject of a FCA lawsuit if the provider is seeking reimbursement through Medicare or Medicaid.
Our whistleblower attorneys are ready to assist individuals with evidence of health care fraud by mental health professionals such as psychiatrists and psychologists. If you have evidence of a violation of the False Claims Act like the ones described above, please call for a free, confidential legal consultation at 1-800-590-4116.
The False Claims Act
The False Claims Act imposes substantial penalties on doctors, hospitals and other health care companies engaged in fraud while rewarding whistleblowers for providing evidence of the misconduct to the Justice Department through a qui tam lawsuit.
Our Federal False Claims Act lawyers have guided whistleblower cases to several significant settlements on behalf of relators. Our largest unsealed cases are currently focused on kickbacks in violation of the Anti-Kickback Statute, but we have a broad base of experience across other types of Medicaid and Medicare fraud. In the pursuit of suspected frauds, we have brought cases to the attention of the government in many states, including New York, Florida, California and here in Philadelphia. In 2016, for example, we helped the federal and state governments recover $54 million from a Valeant subsidiary for kickbacks paid through speaker programs.
The law rewards whistleblowers for information with between 15 and 30 percent of the proceeds from the litigation, subject to numerous terms and conditions specified in the law. During President Obama's Administration, the U.S. paid out more than $4 billion to whistleblowers. For those not familiar with whistleblower cases, we have written a quick guide to the process.
Our False Claims Act attorneys undertake a thorough review of whistleblower evidence up front during the case evaluation process. We confirm that there is sufficient evidence of both inappropriate government billings as well as evidence of intentional or reckless conduct by the individuals in charge. We understand that no one person needs to have every piece of the puzzle and we have evaluated thousands of potential cases while honing our judgment. We also answer any questions that a whistleblower has in order to ensure that you can make an informed judgment about whether to proceed with a qui tam lawsuit.
To begin the process and get your questions answered, use our contact form or call 1-800-590-4116 for a free, confidential and no-obligation initial legal consultation from our whistleblower attorneys.