Connecticut AG Settles with Psychiatrist who Allegedly SubmittedFalse Claims to the Connecticut Medicaid Program
Seattle Whistleblower Attorneys report that a Connecticut base psychiatrist and her husband will pay $400,000 to settle a civil False Claims Act lawsuit originally filed by the Connecticut Attorney General in June 2015 alleging that the couple engaged in a long term scheme to submit false claims for services provided to Medicaid patients in Connecticut.
The Connecticut AG alleged that the co-owners of Brighter Concept, Inc. – Dr. Ashwini Sabnis, a licensed psychiatrist enrolled as a provider in the Connecticut Medical Assistance Program (CMAP), and her husband, Saurav "Sam" Mohanty – participated in an illegal scheme that resulted in the submission of false claims for services that were not provided and claims that were "upcoded".
The practice of "upcoding" occurs when a provider knowingly uses a higher-paying code on the claim form for a CMAP recipient to reflect the use of a more expensive service, procedure or device than was actually used or was medically necessary.
"The submission of false claims to federal and state health care programs is illegal," said Attorney General Jepsen. "My office will continue to actively pursue and hold accountable those who attempt to take advantage of Medicaid and other taxpayer-funded healthcare programs."
The state alleged that, from January 2010 through at least July 2012, Sabnis and Mohanty illegally submitted false claims for reimbursement while knowingly retaining and concealing the overpayment. Sabnis allegedly scheduled her Medicaid patients for 15 or 30 minute appointments. However, evidence developed during the investigation, revealed that these appointments were often double, triple and, in some cases, quadruple booked.
When submitting for reimbursement, the state alleged that Sabnis consistently used a reimbursement code which required her to see the patient for approximately 75 to 80 minutes when, in fact, she saw the patient for as little as 5-10 minutes. The state identified 113 days between January 2010 and January 2012 where Sabnis billed the CMAP for more than 24 hours of service.
In addition, the state alleged that Sabnis and Mohanty attempted to conceal from Department of Social Services (DSS) auditors the existence of computer databases that contained information which would have evidenced that the claims were false and that the couple attempted to alter patient records. The effort to conceal this information and retain overpayments continued even after the Attorney General began his investigation.
Under the terms of the settlement, Sabnis and Mohanty did not admit liability but have agreed to payments totaling $400,000.00 to the CMAP. Additionally, under a separate agreement with DSS, Sabnis will be suspended and excluded from participation in CMAP for three years.
DSS Commissioner Roderick L. Bremby said, "While not representing Medicaid-enrolled providers as a whole, this is a disturbing reminder that anti-fraud and program integrity measures are absolutely necessary to protect taxpayer investments in public health coverage. Once again, we thank Attorney General Jepsen and his staff, the Chief State’s Attorney’s Office, as well as our federal partners, for their outstanding work in coordination with DSS quality assurance investigators."
Please click here to view the settlement documents.
Source: Connecticut AG's Office