Pediatric group to pay $739,759 to settle Medicaid over-billing: attorney general
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Dec. 23—Attorney General William Tong today announced a settlement with a local pediatric provider and its owner over fraudulent claims that resulted in excessive Medicaid charges.
Manchester Pediatric Associates and its owner, Dr. Swathanthra Melekote, agreed to pay $739,759.52 for submitting false and fraudulent claims between January 2015 and May 2021, resulting in overbilling of the Connecticut Medicaid Program, Tong said in a news release.
Tong said that over five years, Manchester Pediatric Associates and Melekote "knowingly and systematically submitted hundreds of thousands of dollars of false claims to the Medicaid program for services he did not perform to maximize his own profit.
"These false claims and fraudulent double billing practices misused Connecticut Medicaid resources intended for the medical care of our state's most vulnerable residents," Tong said.
Manchester Pediatric Associates serves approximately 5,700 pediatric Medicaid patients in South Windsor, Torrington, and Tolland, Tong said.
Tong said his office began investigating after receiving a whistleblower complaint, working with the Department of Social Services Special Investigations Unit. The investigation found that Melekote directed staff to attach numerical "modifiers" to the codes entered on the electronic claim for payment to dupe the processing system.
The investigation — which included a review of claims data for MPA Medicaid patients' medical records, as well as extensive interviews with current and former MPA employees — found that Melekote double-billed Medicaid for maternal depression screenings and vaccine administration and billed for medical services as if a physician had provided the services, instead of a physician assistant or nurse practitioner, which would have been reimbursed at a lower rate, Tong said.
The settlement will be paid no later than Dec. 30, 2021, the release said. The money will be returned to the Medicaid program, Department of Social Services Commissioner Deidre S. Gifford said.
"The Office of the Attorney General takes seriously our responsibility to safeguard our public healthcare programs and is prepared to take strong action against anyone who violates that public trust."
Austin Mirmina covers Manchester and Bolton.
