AG: New Haven Clinician to Pay $100,000 to Settle False Claims Act Allegations

Connecticut Attorney General William Tong. Courtesy photo.

The Office of Connecticut Attorney General William Tong announced Thursday it has reached a settlement with a New Haven-based behavioral health provider that calls for the business' owner to pay $100,000 and to be suspended from taking part in the state's Medicaid program for 10 years.

The agreement was finalized this week between the Office of the Attorney General and Lamaara Davis, owner and chief executive officer of the Davis Group, which operated Caring Family Solutions.

The Davis Group admitted no wrongdoing. Its Caring Family Solutions is no longer in operation.

According to the Office of the Attorney General and the state Department of Social Services, the Davis Group allegedly engaged in a systematic and long-term pattern of submitting false claims to the Connecticut Medicaid program. The Davis Group enrolled in the Connecticut Medical Assistance Program, or the state's Medicaid program, in 2014 as a behavioral health clinician group.

A three-year state investigation beginning in April 2014 found the Davis Group allegedly submitted claims for psychotherapy services by licensed behavioral health providers to Connecticut Medicaid patients. But the state alleges unlicensed individuals provided the vast majority of those services, in violation of CMAP regulations.

The state says the settlement and suspension from the state's Medicaid program is to resolve allegations under the False Claims Act, which criminalizes fraudulent billing of any federal or state health care program.

The state investigation developed evidence that in some cases psychotherapy services were never provided to patients, and that patients were not physically present on the dates that services were purportedly provided. In some cases, the state said it found the services provided were not psychotherapy services, but instead were services such as homework assistance or recreational activities. Such services are not eligible for reimbursement through CMAP.

Tong, Connecticut's top prosecutor, said his office would pursue fraudsters.

"The DSS relies on the accuracy and truthfulness of the information provided on claims for services when it reimburses health care providers," he said. "Services performed by unlicensed providers expose Medicaid patients to substandard care and undermine the integrity of our health care system. When providers engage in false and fraudulent schemes, they will be held accountable by my office."

Davis could be not reached by press time. The Davis Group is represented by Parrett, Porto, Parese & Colwell attorney Tamar Birckhead, who did not respond to a request for comment Thursday.

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