Two mental health providers in the South Texas area, Texas Behavioral Health PLLC (TBH) and United Psychiatry Institute LLC (UPI), have agreed to pay $1,083,000 to resolve allegations that they falsely billed Medicare, TRICARE, and Medicaid for services not rendered by physicians or under their direct supervision, as required by regulations.
The whistleblower in this case will receive 17% of the settlement proceeds.
From 2017 through 2020, Texas Behavioral Health PLLC (TBH) and United Psychiatry Institute LLC (UPI) allegedly engaged in a pattern and practice of falsely billing Medicare Part B.
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“For a system to provide affordable mental health services, it’s important for healthcare providers to give accurate information about who is providing the services – not supply misinformation in an attempt to fleece that system,” said Hamdani. “My office will continue to hold healthcare providers accountable when they get reimbursed at a higher rate due to alleged improper or fraudulent billing practices.”
According to the allegations, TBH and UPI would submit claims for mental health services that physicians had not rendered or not directly supervised as Medicare regulations require.
Some services occurred on dates when the physicians were traveling outside of the United States and thus unable to provide the services.
Others allegedly occurred at times when it was not logistically possible for the physicians to have rendered them or directly supervised the services themselves due to the sheer volume of patients at multiple office locations located in and around the Houston area.
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“As evidenced by recent settlements and indictments, healthcare fraud and abuse of our federally funded healthcare system is rampant,” said Special Agent in Charge Douglas Williams of the FBI Houston Field Office. “Too many providers are taking advantage of the mental health crisis and patient beneficiaries to bilk the system for millions of dollars. Ultimately, we all pay the price for their deceit in the form of higher premiums and out-of-pocket expenses. We encourage anyone who has information about healthcare fraud to please speak up and report it to the FBI.”
The settlement stems from a whistleblower lawsuit filed under the False Claims Act, which allows individuals to sue on behalf of the government and receive a portion of any recovery.
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