Several Virginia clinics have been given a healthy fine after allegations of overbilling Medicaid patients surfaced.
The Justice Department and The Commonwealth of Virginia have reached a settlement figure with these clinics that all fall under the Crossroads chain.
They allege that the clinics in question took advantage of patients seeking care for substance abuse and knowingly overbilled them.
Special Agent in Charge Tamala E. Miles with the Department of Health and Human Services Office of Inspector General (HHS-OIG) commented on the case. She said, “Submitting false claims to Medicaid undermines the integrity of the program and wastes valuable taxpayer dollars.”
Virginia clinics to pay settlement figure
According to the Justice Department report the clinics submitted false and fraudulent claims when billing for Medicaid patients.
The Crossroads chain is headquartered in Greenville, South Carolina, but operates in multiple locations. Including:
- Crossroads Treatment Center of Petersburg P.C.
- ARS Treatment Centers of New Jersey P.C.
- Crossroads Treatment Center of Greensboro P.C.
- Starting Point of Virginia P.C.
In these locations, it was found that from 2016 until mid-2023, there were no routine policies and practices followed when submitting claims to Virginia Medicaid.
The code (99215) related to patient appointments that followed “least two of the following three components: a comprehensive medical history, a comprehensive medical examination, and medical decision making of high complexity.”
These components were not present and patients were not met at scheduled appointments. The standards within these facilities, in short, failed to meet the required minimums, but Crossroads billed their Medicaid programs regardless.
The case against Crossroads was brought forward by a former Director of Network Management at the company. For their involvement in this whistleblower case, they will take home $60,671 as their share of the recouped funds.
Of the settlement figure of $863,934, the United States will receive $356,891 and the Commonwealth of Virginia will be allocated $507,043.
On the settlement figure, the head of the Justice Department’s Civil Division, Principal Deputy Assistant Attorney General Brian M. Boynton, said “Providers may bill only for the services that they actually provide.”
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