Policy & Regulation News

Catholic Charities reaches false Medicaid claims settlement

By Elizabeth Snell

- Catholic Charities West Michigan reached a settlement with the US Attorney’s Office for the Western District of Michigan over the non-profit organization submitting false Medicaid claims. Under the agreement, Catholic Charities must implement a compliance program and hire an independent organization to review its claims for behavioral health services under penalty of a potential exclusion from federal healthcare programs, according to a US Attorney’s Office statement.

The compliance program must last at least two years, and Catholic Charities is required to report certain violations – those of state or federal criminal, civil, or administrative laws - to the US Attorney’s Office. The organization must also implement written procedures to ensure the billing codes used to submit claims to insurers are accurate. Lastly, Catholic Charities needs to create a way for billing concerns and other issues to be reported anonymously and confidentially, without retribution or retaliation by Catholic Charities.

“[The settlement] resolves allegations that between May 1, 2010 and December 31, 2013, Catholic Charities’ Behavioral Health Unit submitted false Medicaid claims for services that were rendered by a Catholic Charities practitioner with a lapsed license, services that did not comply with applicable supervision and documentation requirements, and services that Catholic Charities upcoded using billing codes for higher-paying services than were actually performed,” the statement read.

As part of the settlement, Catholic Charities acknowledged that it should have known it submitted claims for services rendered by a practitioner with a lapsed license and used billing codes for longer therapy sessions than were provided to patients.

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  • Should Catholic Charities materially default on its settlement obligations, the US Attorney’s Office will refer the organization to the US Department of Health and Human Services, Office of Inspector General (“HHS-OIG”) for potential exclusion from federal health care programs, according to the federal statement. Catholic Charities said that it would not challenge any exclusions if they occur.

    Terry Walsh, president and CEO of Catholic Charities West Michigan, explained to MLive that his agency conducted an internal investigation after the allegations were first raised. Approximately $20,000 – a small percent of the agency’s annual budget, according to Walsh – was found to be involved. Walsh added that Catholic Charities reimbursed those who covered those costs.

    Catholic Charities West Michigan “is committed to providing quality behavioral health services and complying with all laws related to the provision of and billing for those services,” Walsh told the news source. “We have entered into a settlement agreement with the US Department of Justice to resolve allegations that a very small percentage of counseling services claims were not properly payable.”