State of Conneticut Reaches False Claims Act Settlement with Providers at Children's Behavioral Health Clinic

From this Conneticut Attorney General Press Release.

A social worker and a doctor will pay a total of $120,000 to Connecticut's Medical Assistance Program (CMAP) through settlement agreements that resolve civil allegations involving the filing of false and fraudulent claims for payments at a Branford-based outpatient behavioral health clinic for children, Attorney General George Jepsen said today.

The state alleged that David M. Meyers, a licensed clinical social worker and former president of Cornerstones P.C., located in Branford, hired Dr. W. Blake Taggart to be the medical director of Cornerstones through an independent contractor agreement. Cornerstones' provider agreement with the state Department of Social Services (DSS) for participation in CMAP – which is the state's Medicaid program – required that the clinic comply with all applicable regulations. The state Department of Children and Families (DCF), which licenses and regulates outpatient psychiatric clinics for children, required Cornerstones to have a medical director. As part of Meyers' effort to maintain his clinic's enrollment in the CMAP beginning in January 2010, the DSS required an updated letter representing that Cornerstones continued to have a medical director overseeing care.

The state alleged that Dr. Taggart resigned as the clinic's medical director in September 2009, but two months later Meyers falsely stated in the letter to DSS that Dr. Taggart remained as the clinic's medical director. The state alleged that Dr. Taggart facilitated this misrepresentation by signing the false, back dated letter to DSS.

[...]

Fairfield psychiatrist charged with fraud. They submitted bills that added up to them seeing patients 24 hours a day.

The state attorney general is suing a Westport couple for Medicaid fraud, charging they submitted bills that added up to them seeing patients 24 hours a day.

Attorney General George Jepsen announced Thursday morning that Dr. Ashwini Sabnis, a psychiatrist, and her husband Saurav “Sam” Mohanty, co-owners of Brighter Concept, Inc., 2000 Post Road in Fairfield, allegedly filed false claims under the Connecticut Medical Assistance Program. The couple also operated a Brighter Concept office in New Haven.

Jepsen said he is seeking triple damages under the state’s False Claims Act for actions that occurred between January, 2010 and December of last year, including billing for services that garnered higher reimbursement levels than the services they actually provided. Jepsen alleged that the couple overbilled the state Department of Social Services by $768,171 during the four-year period.

The lawsuit, pursued by Jepsen and Department of Consumer Protection Commissioner Jonathan Harris, was filed in Hartford Superior Court.

"This action is being brought to seek damages, civil penalties and other relief due to a scheme that was perpetrated on a health care program intended to care for our most vulnerable citizens," Jepsen said in a statement. "Health care providers who accept taxpayer dollars must play by the rules."

The couple’s attorney, Ross Garber, declined comment.

The 42-page complaint alleges that the scheme included claims for services not rendered, as well as overbilling and filing false statements in a “systematic and persistent pattern of submitting false and fraudulent claims.” The lawsuit alleges that Sabnis and Mohanty discouraged auditors from the state Department of Social Services with claims that their computer system had crashed.

Sabnis regularly overbooked her scheduled Medicaid patients for 15 or 30 minute appointments, saw them for as little as 5 or 10 minutes, then used a reimbursement code that showed she spent as much as 75 to 80 minutes with them, the complaint said. The lawsuit alleges that there were 113 days when Sabnis billed the state for more than 24 hours of service for low-income and disabled patients.

Department of Social Services Commissioner Roderick L. Bremby praised the Attorney General’s investigation.

“Uprooting and eliminating this type of fraudulent activity requires the constant vigilance of oversight agencies,” Bremby said. “While the great majority of Medicaid-enrolled providers are professional and honest, the exceptions require aggressive action on behalf of the program’s overall integrity and the taxpayers who fund it.”

Psychiatrist had been previously investigated, and now faces more complaints

Report From the Hartford Courant

On Feb. 14, 2002, Attorney General Richard Blumenthal asked Connecticut health regulators to yank Dr. Peter Benet's license to practice medicine, calling the psychiatrist a "physician who sacrificed his patients for money and power."

But the state didn't take action. Benet continued to see patients. Now he is facing disciplinary action by the Department of Public Health, based on two unrelated complaints.

Those complaints, Blumenthal said, might have been prevented if the health department had listened to him six years ago when he recommended that Benet's medical license be suspended or revoked.

"Tragically and unfortunately, these latest complaints vindicate the serious recommendations we made years ago," Blumenthal said. "We issued a scathing report that left no doubt about this physician arbitrarily denying medically necessary care to patients."

A spokesman for the Department of Public Health refused to explain why nothing was done six years ago, citing department policy. Blumenthal said his office is now looking into possible further legal action against Benet.

At the time that Blumenthal issued his 2002 report, Benet was the founder and medical director of Psych Management Inc., a firm that Anthem Blue Cross-Blue Shield hired to manage mental health care for Anthem's HMO.

Blumenthal found that Anthem's low payments to Psych Management, also known as PMI, combined with financial misdeeds by Benet, resulted in at least one patient, and probably others, being denied necessary mental health care.

"Dr. Benet devised a plan to bilk [PMI] of its assets and profit personally," Blumenthal's report alleges. At the same time that Benet was denying care to patients, Blumenthal contended, Benet was using company funds to support a lavish lifestyle.

"This report presents a picture of a physician driven by the promise of wealth to disregard health needs," Blumenthal said at the time.

Although Blumenthal's investigation was related to the psychiatrist's business practices, and not directly to his own care of patients, the attorney general said he had reason to suspect at that time that Benet could pose a risk to patients. He said his call for revocation or suspension of Benet's license — a move Blumenthal called "highly extraordinary" — was an indication of the seriousness of his concerns.

Earlier this year, Benet agreed to pay a $3,000 fine as part of a consent order he reached with the state in connection with a complaint that Anne Kristine Blake filed. Blake started treatment at Benet's South Windsor office about three months after Blumenthal issued his report in 2002. Although the names of patients who file complaints with the health department are kept confidential, Blake, of Manchester, has come forward and identified herself.

Health department investigators found that during his treatment of Blake, Benet "deviated from the applicable standard of care" by failing to adequately justify his diagnoses of post-traumatic stress disorder and bipolar disorder and by failing to coordinate his prescription for lithium — a drug used to treat bipolar disorder — with the diagnosis that Blake had a thyroid condition, documents show.

In addition to the fine, Benet was ordered to take a class in diagnosing, treating and documenting mood disorders.

The disciplinary action is listed on Benet's physician profile, a public record designed to help would-be patients make more informed decisions when selecting a doctor. It was not, however, reported to the National Practitioner Data Bank, a federal clearinghouse of doctors who have run into disciplinary trouble.

William Gerrish, a spokesman for the Connecticut Department of Public Health, said the federal data bank requires the state to report only reprimands and other more serious disciplinary actions against a doctor's license. He said the state was not required to report the action against Benet because it was only a fine.

Another Case

A second case against Benet is scheduled to be heard by the Connecticut Medical Examining Board at hearings set to begin Sept. 26. The board is a volunteer panel of doctors that works alongside the health department to monitor members of the profession. Cases are usually sent to the examining board when a settlement cannot be worked out between the health department and the doctor.

In that case, a patient identified as P.M. sought care at Benet's South Windsor office in 2004 — two years after the Blumenthal report. In a complaint to the health department, the patient accused Benet of prescribing a dangerous combination of medications.

In a statement of allegations against Benet sent to the medical examining board in May, health department investigators said that Benet prescribed two drugs to treat schizophrenia that could be harmful to people with high blood pressure and Type 2 diabetes, both of which the patient had.

Benet also prescribed five medications for insomnia at once without ordering a sleep study or warning the patient about the possible side effects, which included deterioration of the patient's mental status, the allegations say.

Benet said he would like to respond to the allegations against him, but cannot because he is bound by an obligation to protect his patient's confidentiality. But he maintained that he did not harm either of the patients who made the complaints.

"If you look at the consent decree, it really comes down to technical documentation issues," he said. "In neither case did any harm come to the patient from anything I did or didn't do."

The consent order in the Blake case says that the department reviewed a large sample of Benet's documentation of cases that required coordinating prescriptions for mood disorders and other conditions and found that his "current practice meets the standard of care."

Bad Reaction

Although Blumenthal's allegations against Benet were the subject of press reports, Blake said she found no public records of complaints against Benet when she found his name on the Internet and made an appointment with him in May 2002.

She was recovering from a back injury and had been embroiled in a dispute with the state Department of Mental Retardation, where she had worked with patients in group homes since 1993.

Then on March 14, 2002, she learned that her closest friend, Renea Ervin, then 34, had died. Ervin's husband, Michael Ervin, was eventually convicted of murder and sentenced to life in prison. During the trial, Blake sat in the courtroom, holding her friend's picture.

"It wasn't just little stresses," Blake said. "They were huge."

But she said the medications Benet prescribed made matters worse.

"I couldn't walk, I couldn't talk, I was not a good mother, I couldn't function," Blake said.

After two years of treatment, Blake left Benet's practice.

In July, she sued Benet in small claims court, seeking $5,000 in damages. She wants Benet to cover co-pays on future prescriptions of alprazolam, better known by its brand name, Xanax, and for future psychiatric care.

She said in an interview that she has been dependent on the tranquilizer since Benet prescribed it for her anxiety and panic attacks.

She said she is functioning well now, working as a volunteer on the presidential campaign of Barack Obama and traveling back and forth to Jamaica, where she donates books to poor, rural schoolchildren.

But she says she remains on disability and continues to be unable to work. And she wishes she had been warned before she sought care from Benet.

"I was very vulnerable," Blake said. "I believed he was trying to help me."

Pfizer Executive Faces Charges In Child Porn Probe

As reported in The Day Pfizer is well known as a manufacturer of many medications, including psychiatric drugs.

Federal agents have charged Pfizer Inc.'s global patent director with receiving, distributing and possessing child pornography and are holding him without bond.

Alan Hesketh, 61, of 202 Montauk Ave., Stonington, is accused of posing as a 28-year-old female while trading hundreds of images of children engaged in sexual acts.

He allegedly traded the images with a man from Buffalo, N.Y., while chatting with him online between June 2006 and May 2007.

The two men discussed, “among other things, the sexual molestation of children involving the use of human defecation,” according to a court document.

Hesketh allegedly used the screen name “Suzibibaby” during the online sessions.

Federal agents found he signed on as “Suzibibaby” from his home in Stonington and from several other Internet addresses, including one registered to Pfizer in New York and another at the Tudor Hotel at the United Nations, where he was a guest for three days in December 2007.

U.S. Immigration and Customs Enforcement agents arrested Hesketh at JFK International Airport in New York on Wednesday.

Hesketh is a British citizen and a permanent resident of the United States, where he has lived since 2002. It did not appear he was trying to flee the country at the time of his arrest, according to a spokesman for the U.S. attorney's office.

Hesketh was presented in U.S. District Court in Hartford on Thursday, where Judge Donna F. Martinez scheduled a bond hearing for Monday afternoon.

Pfizer spokeswoman Liz Power said Thursday that Hesketh, whose office is in New London, is on a leave of absence from the company.

“Pfizer will cooperate with authorities in any investigation,” she said.

Hesketh is the company's vice president and global head of patents, which is a part of the legal division of Pfizer Inc.

According to an affidavit prepared by Special Agent Jason P. Dragon, an investigation that began in Buffalo in June 2007 led authorities to Hesketh.

Federal agents suspected Buffalo resident Gregory Nadolski of sharing and receiving images of child pornography via the Google “hello” file-sharing program, which enables users to share digital images with one another while chatting online.

The authorities seized two computers from Nadolski, who admitted to possessing child pornography and trading images online using the screen name “mrko9850.”

Nadolski's computer contained 27 “hello” chat logs between the screen names “mrko9850” and “Suzibibaby” — Hesketh's alleged screen name. The two shared more than 1,000 images, many of which appeared to contain child pornography.

The Buffalo office on Feb. 22 turned over a disk containing the images and video files to Dragon, the Hartford agent.

Dragon prepared a 40-page affidavit, dated March 26, that requests a judge's permission to search the Montauk Avenue, Stonington, home where Hesketh resides with Jan Hesketh and to seize Hesketh's computer. It was unclear Thursday evening whether the search has been conducted.

The affidavit contains the text of a “hello” chat conversation that allegedly took place between Hesketh and Nadolski in the early-morning hours of April 24, 2007. The two sent 85 photos back and forth to one another while carrying on an explicit discussion involving babies, feces and sexual acts.

At one point, “Suzibibaby” sent “mrko9850” a picture of “herself.” The pictured depicted a 25- to 30-year-old woman, according to the court document.

As a defendant in a federal court case, Hesketh is entitled to have the case presented to a grand jury. If he is indicted and convicted, he faces a mandatory minimum of five years in prison and maximum term of 20 years for receiving and distributing child pornography and a maximum of 10 years in prison for possession of child porn. He also faces as much as $500,000 in fines.

Hesketh is being prosecuted as part of the U.S. Department of Justice's Project Safe Childhood Initiative, which is aimed at protecting children from sexual abuse and exploitation.

Psychiatrist loses license due to 'predatory behavior'

We have this report from the Republican American Prospect, out of Waterbury, Connecticut. The bureaucratic speak in the news story just spin talk for "He is suspected of screwing his patients"

Jeremy August, a psychiatrist with a practice in town for 27 years, has lost his license because of what a state board called "predatory behavior and repeated boundary violations" with his patients.

On Feb. 19, the Connecticut Medical Examining Board revoked his license to practice medicine and surgery.

The board's decision came after reviewing allegations that August had been seen hugging and kissing a patient and continued to speak with her on the telephone after she moved to Illinois, according to documents filed by the board in February.

Combined with previous complaints against the psychiatrist dating back to 1999, August's actions established "a pattern of predatory behavior and repeated boundary violations that pose a real and current danger to psychiatric patients," according to a memorandum of the board's decision.

August, who closed his Waterbury Road office after his license was suspended in June, said he plans to challenge the medical examining board's decision, which he says is based on unsubstantiated allegations.

Hartford Hospital On Probation, - Problems include a variety of psychiatric abuses.

We highlight the deficiencies in the psychiatric departments, but it sounds like the whole place is a mess. From the Hartford Courant

Citing multiple lapses in patient care — including four cases in which patients died — the state health department placed Hartford Hospital on probation Friday, demanding sweeping changes in the way the 800-bed teaching hospital delivers care.

"Frankly, we thought we were doing a better job than is identified in the report," said John Meehan, president and chief executive officer of the hospital.

[...]

The disciplinary action — one of the most serious the state can impose — grew out of an investigation that started after the health department received at least 28 complaints from dissatisfied patients or families from 2005 to 2007.

[...]

The fourth death was that of Marcia Maglisco, a Newington grandmother who was taken to Hartford Hospital in October 2007 after her grandson was found dead in a bathtub while she was caring for him.

Although Maglisco was distraught and spoke about suicide, she was discharged from the emergency room several hours after police brought her in. A psychiatrist told her to return to the hospital if she had further problems,the state report says. There was no written documentation of further follow-up instructions.

Maglisco hanged herself in her home a short time later.

[...]

A nurse slapped a distraught psychiatric patient in the face after the patient spit at the nurse, the state says. A psychiatric technician who was punched by a patient retaliated by punching the patient back multiple times.

The report also details deficiencies in the buildings at Hartford Hospital's psychiatric facility, the Institute of Living, that made it possible for patients there to attempt suicide. One patient tried to kill himself by hanging himself from a bedsheet attached to a closet door hinge.

[...]

Woman's Estate Sues Over Suicide at Connecticut Psychiatric Hospital

From this report in the Danbury News Times

The Rev. Dale Rosenberger remembers his friend Ruth Farrell as "a lost soul in whom light still shone."

Farrell, who was a Ridgefield resident, died nearly six years ago, and her death has become the subject of a malpractice suit brought by David Kervick, the executor of her estate, against Silver Hill Hospital in New Canaan and Farrell's psychiatrist there, Dr. Ellyn Shander.

Farrell, who was 41 when she died, reportedly committed suicide Jan. 28, 2002, while a patient at Silver Hill. She was found hanging from a bathroom door, according to court documents.

The suit -- believed to be only the second such one in Connecticut history filed against a hospital following a patient's suicide -- is now before a jury in Stamford Superior Court.

[...] court documents reveal Farrell had been a patient at Silver Hill Hospital "on various occasions" since 1999.

Over those years, she exhibited "suicidal behavior" and made suicide attempts, according to the suit. The hospital and her psychiatrist should have been aware that she was at risk, the suit alleges.

In response to the suit, Silver Hill Hospital denies Farrell was a suicide risk at the time of her admission in January 2002 and claims in court documents that it was Kervick's "abusive" relationship with Farrell that drove her to suicide.

Danbury attorney Gregory Klein, who is not involved in the case, spoke generally about similar cases.

He noted that in reviewing the state of Connecticut Judicial Branch Web site, he found only two cases, including Kervick's, of a patient or patient's estate suing a hospital for malpractice after a suicide.

Klein cited a similar case "where a doctor who was the victim of childhood sexual abuse hanged herself while committed to the hospital." The plaintiff's estate was compensated in that case, Klein said.

"Places like Silver Hill are entrusted to care for and manage people who cannot do it for themselves," he said. "When there is known suicidal ideation, the hospital's responsibility is to be vigilant in taking all steps necessary to prevent that outcome."

Silver Hill is a 76-year-old nonprofit hospital specializing in treating psychiatric disorders and substance abuse. It sits on 45 acres that include walking trails and tennis courts.

It has treated celebrities like Billy Joel and Mariah Carey in its country club-like setting.

[...]

Doctors Must Stop Pushing Pills

As seen in the Daily Campus from the University of Connecticut

Reality should not resemble the book "Running with Scissors," where a seemingly practiced psychiatrist offers his patients the latest sample of medicine that comes in the mail. The problem of crooked or uninformed doctors is nothing new. However, more and more people in the U.S. are being prescribed medications that are unnecessary and potentially dangerous to their condition, and, thankfully, people are starting to worry. This does not only happen with illness related drugs, as mental illness medications are being more often prescribed to cover up the symptoms of a disorder without helping cure it at all. At times, these medications do not affect the disorder at all. In contrast, some medications make the disorder worse or present the patient with side effects worse than the actual disorder.

More recently, several states have begun to notice how much antipsychotic medicine is costing people and affecting their health, perhaps unnecessarily. Eli Lilly, the manufacturer of the antipsychotic drug Zyprexa, is attempting to monitor doctors' prescriptions of the drug. The New York Times reports that, "at more than $300 for a monthly prescription, Zyprexa, which is used to treat schizophrenia and bipolar disorder, is the single biggest drug cost for state Medicaid budgets." Another worry for the drug is its side effects. Zyprexa has been known to put users at greater risk for heart attacks, strokes, diabetes, high blood pressure, dizziness, etc.

[...]

Over the past few years, there have been a growing number of patients that have died or experienced unfit side effects from badly prescribed medication. Not only have some side effects caused physical harm such as heart attack and death, but they have also created dangerous mental conditions. According to Sage Journals, a psychopharmacology journal, some patients with schizophrenia who take the anti-psychotic medication Clozapine will feel like they are entirely cured, while others may experience heightened hallucinations and psychotic episodes.

There isn't always a definite medication for a specific mental illness. Medications need to be prescribed with close psychological and bodily supervision. Too many people have had suicidal thoughts, or terrifying hallucinations, because of simply taking the wrong drug. Instead of prescribing medication for a certain disorder, doctors should obtain more specific symptoms and perhaps even wait to prescribe a specific medication until they learn more about the individual patient's condition. Additionally, doctors should obtain more evidence about a given drug and all of its side effects.

Not many people know that Prozac was originally approved to treat a heart condition. Psychiatrist Robert Post of the National Institute of Mental Health said that "research shows that antidepressants should be used the way digitalis is used for heart disease." Today, Prozac is a common anti-depressant, and isn't recommended for heart condition medication, but it may once again be suggested as a heart treatment. Because drugs may have multiple positive and negative effects, their uses must be monitored strictly.

In addition to failing to find the perfect mental illness medication for adults, doctors also struggle to find the perfect medication for children. Adults can better explain their symptoms and changes in their conditions, while children have a much harder time explaining and expressing their state and concerns. Because of this, doctors have to monitor children's prescriptions even more vigilantly than adults. In August, 2005, 12 children died from the ADHD medication known as Adderall. Studies found that five of the children had heart conditions. After that episode, heart condition was added to the label of Adderall. However, seven other children died on Adderall without explanation. This wasn't enough to take Adderall off the market because there was not enough conclusive evidence. However, since that case there have been more child deaths due to Adderall and other sedative medications. This is evidence that doctors need to look more closely into what they are prescribing.

Sadly, only some doctors take precautionary measures against careless prescribing. The majority of doctors need to prescribe medication more carefully and have more follow up appointments with their patients. This will cause the patient to spend less money on unnecessary drugs, it will help the patient's condition rather than simply masking it, and fewer people will suffer preventable side effects. In order to treat mental illness well, prescriptions must be supervised more closely.

Town undecided on what to do with closed psych hospital

The Fairfield State Hospital in Connecticut was established in 1933, and was closed in 1995. Facilities included a large farm, a sewage treatment plant and a dozen major buildings as well as staff housing. In 1998, Fairfield Hills consisted of 100 buildings on a 185-acre campus. Fairfield Hills was one of the largest mental health facilities in the state until it closed its door in 1995. At its peak it housed over 4,000 patients. The main campus consists mostly of large 2-3 story buildings ranging in size from 15,000-200,000 square feet. There are alot other smaller buildings on the edge of the campus that had served as living quarters for staff. Architecturally, the buildings of the complex are more interesting than many other institutional buildings built during the 1930s.

The Newtown, Connecticut community currently has plans underway to find new uses for the complex. As seen in this report, the town is still discussing what to do with the facility, having rejected the most recent master plan from the Planning and Zonning Commision. More details here

Fairfield Hills had a reputation for problems between administrators and employees as well as other unpleasant issues such as patient escapes, mistreatment of patients, and mysterious deaths.

There are an unusual number of websites dedicated to the former facility.