Conn. Reaches State-Federal Settlement with Hartford Dispensary to Resolve False Claims Act Allegations
released on September 7, 2017
found in newsletter: September 2017
The Hartford Dispensary will pay $627,000 through a federal-state settlement to resolve allegations that it violated the False Claims Act by falsely certifying to federal and state officials that it had a current medical director that was performing his duties in accordance with federal and state law, Attorney General George Jepsen and state Department of Social Services (DSS) Commissioner Roderick L. Bremby said today.
In 2014, the Office of the Attorney General commenced an investigation after a whistleblower complaint about the Hartford Dispensary, a private nonprofit behavioral health organization; the investigation was followed by a qui tam lawsuit alleging various violations of the state and federal False Claims Act. The state’s investigation focused on services that Hartford Dispensary provides as an opioid treatment program – primarily methadone and detoxification services.
Hartford Dispensary has been enrolled as an outpatient medication-assisted treatment provider in the Connecticut Medical Assistance Program (CMAP) – Connecticut’s Medicaid program – since at least 2008. Their provider agreement with DSS – which is the administering state agency for Connecticut’s Medicaid program – requires certification that the program is in compliance with federal regulatory guidelines. Federal guidelines required Hartford Dispensary to have a medical director who either personally administers all of its medical services or who directly supervises the physicians and healthcare professionals performing those services.
Hartford Dispensary’s board appointed a licensed physician as medical director in 1986, a position the physician held until Hartford Dispensary announced the physician’s retirement in 2015. The state and federal government alleged, however, that despite the certifications, the physician performed none of the duties of a medical director at Hartford Dispensary for at least 10 years.
The qui tam lawsuit, which the state and federal government joined, alleged that the physician had not treated any patients in many years, that the physician does not appear on the Hartford Dispensary clinic physician schedules, that the physician had not performed any on-site management or oversight of Hartford Dispensary’s medical services and that the physician had not visited any of Hartford Dispensary’s nine clinics. They further alleged that the physician had not reviewed staffing patterns, performed quality assurance, participated in hiring or been involved in development or enforcement of compliance programs.
The physician is no longer actively practicing medicine. The Hartford Dispensary’s long-time executive director, Paul McLaughlin – who the state and federal government alleged authorized the submission of the false certifications about the organization’s medical director – announced his retirement in January 2017.
“Federal law requires that a medical director oversee Medicaid-enrolled opioid treatment programs. The rationale for the law is self-evident; yet, the requirement takes on added importance in light of the opioid epidemic our state and nation currently faces. A hands-on, onsite Medical Director is responsible for assuring regulatory compliance by monitoring and supervising all medical and nursing services provided by the clinic,” said Attorney General Jepsen. “Opioid treatment clinics are required to follow the same clear rules, and those that do not will face enforcement. I’m grateful to our state and federal partners for their continued cooperation and coordination as we work to protect our taxpayer-funded healthcare programs.”
“A medical director has critical functions in the management of practitioners, adherence to clinical guidelines and ensuring overall quality of care,” said Commissioner Bremby. “Operating without a medical director or, in this case, operating with a no-show or non-participating medical director, is inexcusable and a gross violation of federal and state requirements. This behavioral health provider is under new leadership and now participates in the Connecticut Medical Assistance Program/Medicaid in accordance with standards and requirements. We thank the Attorney General’s Office for its work in this whistleblower case, as well as additional state and federal partners for ongoing anti-fraud actions with DSS investigators.”
A qui tam lawsuit is a civil lawsuit that a whistleblower can bring under the state or federal False Claims Acts. Qui tam lawsuits can allow whistleblowers, known as relators, to share in recovered funds and other relief if a case is resolved in the government’s favor.
Of the $627,000 in settlement funds, the qui tam relators who alerted the government in this case will receive $112,860. The remainder of the settlement funds, $514,140, will be returned to the CMAP. The State of Connecticut’s share of these funds is $308,484.
The Attorney General and Commissioner Bremby thanked U.S. Attorney Deirdre Daly and her staff and the United States Health and Human Services Office of the Inspector General – Office of Investigations for their work on this matter.
Today’s action is part of a larger effort by the State of Connecticut’s Interagency Fraud Task Force, which was created in July 2013 to wage a coordinated and proactive effort to investigate and prosecute healthcare fraud directed at state healthcare and human service programs. The task force includes a number of Connecticut agencies and works with federal counterparts in the U.S. Attorney’s Office and the U.S. Health and Human Services, Office of Inspector General – Office of Investigations. For more information, please visit www.fightfraud.ct.gov.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Antitrust and Government Program Fraud Department at 860-808-5040 or by email at firstname.lastname@example.org; the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney at 860-258-5986 or by email at email@example.com; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud, or by email to firstname.lastname@example.org.
Assistant Attorneys General Gregory O’Connell and Michael Cole, chief of the Antitrust and Government Program Fraud Department, assisted the Attorney General with this matter.
Please click here to view a copy of the settlement document.
Original Press Release