Prism Behavioral Solutions, a provider of Applied Behavioral Analysis therapy to “children diagnosed with autism and other related disorders,” will pay $650,000 to resolve allegations that it billed Medi-Cal, California’s Medicaid Program, for services it did not provide. The case stemmed from a whistleblower’s qui tam lawsuit, and the whistleblower in this case will receive $130,000.
The qui tam provisions of the False Claims Act enable private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery, if one occurs.
Prism Behavioral Solutions serves patients in Southern California. The U.S. government and the State of California allege that Prism Behavioral Solutions “violated the federal False Claims Act and the California False Claims Act by knowingly submitting false claims to Medi-Cal for medical services that [it] did not perform from September 2016 through December 2019.” The whistleblower’s complaint alleged that Prism Behavioral Solutions billed Medi-Cal “for cancelled appointments.”
“Billing government health care programs for services not rendered negatively impacts the entire health care system,” said U.S. Attorney Randy S. Grossman in the press release. “This settlement shows our continuing commitment to protect the integrity of government health care programs and other taxpayer-funded programs.” In the press release, Grossman also thanks the whistleblower in the case for coming forward.
The False Claims Act in 2021
The U.S. Department of Justice’s (DOJ) data from Fiscal Year 2021 about the False Claims Act described healthcare fraud as “once again the leading source of the department’s False Claims Act settlements and judgements.” However, in FY 2021, “the DOJ only paid out $237 million to whistleblowers, the lowest single-year total since FY 2008,” WNN reports. Whistleblower attorney Stephen M. Kohn said that the FY 2021 totals “reflect a troubling trend in recent years…The DOJ has begun to treat whistleblowers like second-class citizens. It routinely throws out strong whistleblower cases without just cause. While the SEC and CFTC are making great strides forward with their whistleblower programs, the Justice Department is in reverse.” Read the full article about the False Claims Act in FY 2021 here.