Edgewater Systems to pay $1.25 million for fraudulent Medicaid billing for mental health services
Edgewater Systems for Balanced Living, Inc., in Gary agreed to a $1.25 million pre-suit settlement for fraudulently billing the Indiana Medicaid system for mental health treatment, according to a Friday release from U.S. Attorney Clifford D. Johnson.
Michael LeBroi, chief information officer for Edgewater, referred comment to Danita Johnson, the agency’s president and CEO. She did not return a request for comment.
Indiana Medicaid, which receives both state and federal funding, requires providers to draft a care plan for clients receiving mental health counseling services that is signed by either a physician or a health service provider in psychology, a provider with a Ph.D. in psychology, before any treatment sessions are conducted or Medicaid is billed for them.
“Despite knowing of the requirement because of negative Indiana Medicaid audits during prior time periods, during the period from November 1, 2012 through and including December 31, 2017, Edgewater repeatedly billed Indiana Medicaid for mental health counseling sessions that failed to meet the requirement,” the release states.
The False Claims Act prohibits an entity from knowingly submitting claims for payment to a Medicaid program that fail to comply with required billing standards, according to the release.
Under the False Claims Act such noncompliant billing constitutes a fraudulent claim even though services were in fact rendered. Edgewater has agreed to pay the United States and the State of Indiana $1.25 million for falsely billing Indiana Medicaid for the mental health counseling sessions.
Ryan Holmes, public information officer for the U.S. Attorney’s Office for the Northern District in Hammond, said via email that he could not release additional information about the settlement.
Online court records reflect a civil suit filed against Edgewater in April 2017 involving the federal False Claims Act and the Indiana Medicaid False Claims Act.
In September 2018, according to court documents, both the U.S. and the state of Indiana consented to a voluntary dismissal without prejudice, meaning the suit could be filed again,
The Indiana Medicaid program provides health care for low income, often uninsured, Indiana residents who cannot otherwise afford needed medical care.
The settlement was reached as a result of an investigation initiated by the United States Attorney’s Office for the Northern District of Indiana with assistance from the Indiana Medicaid Fraud Control Unit within the Indiana Attorney General’s Office. Assistant United States Attorney Wayne T. Ault handled the settlement negotiations.
