Mental health center to repay $556,687

A press release from the Massachusetts Attorney General

A not-for-profit, mental health and social services provider with several facilities located in suburbs north of Boston has paid $556,687 to the state Medicaid Program and the Massachusetts Department of Mental Health (DMH) to settle allegations they billed the program for services they allegedly never rendered. In addition to payment of the settlement, Tri-City Mental Health Center has entered into a compliance program under the terms of today's agreement with Attorney General Martha Coakley, United States Attorney Michael J. Sullivan and the Office of Inspector General, United States Department of Health and Human Services (OIG-HHS).

Tri-City Mental Health, as a state Medicaid provider and DMH contractor, is required by state and federal law and regulation to submit claims for payment based on necessary services which were actually provided to patients. In addition, they are required to maintain accurate documentation which substantiates the services rendered.

Employee complaints in 2003 lead Tri-City to internally investigate certain claims submitted to Medicaid and DMH by one of its service centers located in Malden. The internal investigation led to the termination of at least one manager at the Malden location and a full scale audit, which was conducted by outside auditors at the request of Tri-City’s Board of Directors. Tri-City notified the Attorney General, DMH and the U.S. Attorney in late 2004 under self-disclosure protocols established by the OIG-HHS.

The joint investigation by the Attorney General and U.S. Attorney, based in part on Tri-City’s own audit, found that from February 2002 through November 2003, there were claims submitted to the state Medicaid program for adult psychiatric day treatment services that were allegedly not supported by documentation or the services had not been provided at all. From September 2001 through October 2003 claims submitted by Tri-City under contracts with DMH for day rehabilitation and social club services allegedly could not be substantiated by documentation or the services were not in fact provided.

In addition to payment of the settlement amount, and in exchange for the release of Tri-City and its Board of Directors from civil and administrative liability, Tri-City has entered into a Certificate of Compliance Agreement with OIG-HHS. This agreement requires Tri-City to establish policies, procedures and reporting obligations to address future conduct and prevent overpayments.

Tri-City Mental Health Center neither admits, nor denies the allegations as part of today's settlement and has cooperated fully with the investigation.

The case was handled jointly by Assistant Attorney General Ann Ackil from the Attorney General's Office and Assistant United States Attorney Patricia Connolly of the Office of United States Attorney for the District of Massachusetts. They were assisted by Steve Devlin, Deputy Chief of Investigations for the Attorney General's Medicaid Fraud Unit, Phil Coyne, Special Agent with OIG-HHS and by Peter Thomas, Director of Compliance and Audit at DMH.