Louisa, Ky.-based Addiction Recovery Care and affiliates Pioneer Health Group and Science Hill Family Care agreed to a $16.2 million civil judgment to resolve allegations they violated the False Claims Act by submitting false claims to the Kentucky Medicaid program, according to a July 27 news release from the U.S. Attorney’s Office for the Eastern District of Kentucky.
Here are three things to know:
- The government alleged the organizations falsely represented the qualifications of some clinicians on Medicaid claims from January 2018 to March 2024 to obtain higher reimbursement rates. It also alleged the organizations billed individual therapy sessions at higher reimbursement rates when group therapy services were provided from July 2019 to mid-June 2021.
- Federal authorities also alleged the affiliates submitted duplicate office visit claims and billed for office visits already reimbursed under an inclusive per diem rate from January 2019 to December 2024. One affiliate also allegedly billed for care management services that did not meet Kentucky Medicaid coverage requirements.
- The judgment will be paid over several years and was reduced based on the defendants’ financial condition and prospects for ongoing operations. The settlement resolves allegations only and there has been no determination of liability, according to the release.
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