Four substance use disorder (SUD) treatment facilities owned by Crossroads Treatment Centers have allegedly knowingly submitted false and fraudulent claims to Medicaid from 2016 to mid-2023.
The company is now set to pay $863,934 in a civil settlement with the U.S. and the Commonwealth of Virginia.
“Submitting false claims to Medicaid undermines the integrity of the program and wastes valuable taxpayer dollars,” Tamala E. Miles, special agent in charge with the Department of Health and Human Services Office of Inspector General (HHS-OIG), said in a statement. “Working closely with our law enforcement partners, HHS-OIG remains committed to investigating providers who allegedly defraud federal health care programs.”
Greenville, South Carolina-based Crossroads operates more than 100 facilities across nine states. The provider offers medication-assisted treatment (MAT), peer support, counseling and care coordination. Revelstoke Capital Partners and Canadian-based Caisse de dépôt et placement du Québec (CDPQ) recapitalized Crossroads in 2022.
The providers allegedly submitted claims to Virginia Medicaid for a patient appointment that includes at least two of three components: a comprehensive medical history, a comprehensive medical examination and a highly complex medical decision.
However, the services provided by the clinics were regular SUD treatment check-ins and did not meet those criteria.
“Providers may bill only for the services that they actually provide,” principal deputy assistant attorney general Brian Boynton, head of the justice department’s civil division, said.
The U.S. will receive almost $357,000 and the Commonwealth of Virginia will receive just over $507,000 of the almost $864,000 payout.
Federal agents began their investigation after a whistleblower filed a lawsuit under the False Claims Act, which allows private parties to sue on behalf of the government when they believe that the accused submitted false claims for government funds.
The whistleblower, a former director of network management and contracting for Crossroads, will receive $60,671 as her share of the federal recovery and an unspecified share of the Commonwealth of Virginia’s recovery.
The following clinics were identified as having submitted false and fraudulent claims: Crossroads Treatment Center of Petersburg P.C., ARS Treatment Centers of New Jersey P.C., Crossroads Treatment Center of Greensboro P.C. and Starting Point of Virginia P.C.
Crossroads declined Addiction Treatment Business’s request to comment on this matter.
Earlier this month, another SUD treatment provider also landed in hot water for fraud.
Michael Brier, the owner of a Rhode Island-based addiction treatment company called Recovery Connections Centers of America (RCCA), pleaded guilty to charges alleging that he and his company defrauded Medicare, Medicaid and other payers out of millions of dollars and kept patients with SUD from getting necessary care.
Brier, who was previously convicted of tax evasion, admitted that he and his company regularly billed Medicare, Medicaid and other health plans for 45-minute counseling sessions while only providing five to 10-minute-long sessions.
Both Brier and RCCA also pleaded guilty to submitting a fraudulent application to Medicare that “misrepresented and concealed” Brier’s role in the business and did not disclose his criminal conviction.
Brier could be sentenced to six to 10 years in prison, followed by three years of federally supervised release. He will also be ordered to pay more than $3.4 million in restitution and forfeit assets including $1 million, his interest in a beachfront condo in Panama, a Mercedes Benz and a Lexus.
The corporate entity RCCA faces maximum penalties of $500,000 or twice the amount of its fraudulent gains or losses, whichever is greater. The company could also be subject to up to five years of probation.
Brier and RCCA are scheduled to be sentenced in November.