U.S. Attorney’s Office Recovers $2 Million from ABA provider
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ASPartOfMe
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Joined: 25 Aug 2013
Age: 67
Gender: Male
Posts: 36,712
Location: Long Island, New York
Quote:
The United States Attorney’s Office for the Southern District of Indiana has recovered $2,000,000 for taxpayers as part of a civil settlement with an Indiana autism therapy provider, ABA Programming Inc., Applied Behavior Center for Autism, and its owner, Sherry Michael (“ABCA”). ABCA is a provider of applied behavior analysis services for clients with autism throughout Indiana. The settlement will resolve allegations that ABCA submitted false claims to the TRICARE and Indiana Medicaid programs.
TRICARE is a health insurance system for members of the uniformed services and their families. It serves millions of beneficiaries, including many Hoosier families. Medicaid provides health coverage to millions of Americans, including low-income adults, children, pregnant women, the elderly, and people with disabilities. It is jointly funded by federal and state governments.
ABCA is a healthcare provider operating in multiple locations throughout the State of Indiana. It provides applied behavior analysis services to individuals with autism spectrum disorder. Sherry Michael is the founder and Chief Executive Officer of ABCA.
According to a settlement agreement between the United States, the State of Indiana, and ABCA, the government maintained that ABCA submitted false claims to the government through several fraudulent billing schemes. These schemes included submitting upcoded, concurrent, and duplicate claims, claims for services not covered by TRICARE, and claims already paid by third-party sources.
Specifically, ABCA submitted claims to TRICARE and Medicaid for Analyst and Technician services rendered concurrently to the same patient, on the same date of service, upcoded claims for services rendered by Technicians, and submitted claims for group therapy services when the services were not covered by TRICARE. ABCA also submitted claims to Medicaid for group therapy services improperly billed as direct one-on-one provider therapy and claims already paid by third-party sources, namely TRICARE and the Indiana CareSource marketplace, without indicating to Medicaid that the claims had already been paid.
Based on the investigation, the estimated loss to the Medicaid program was $348,194.60 and the estimated loss to TRICARE was $626,795.90. ABCA has agreed to pay $2,000,000 to the United States and the State of Indiana to resolve the government’s allegations, which includes double damages and some of the government’s investigative costs. This settlement is the largest TRICARE settlement ever collected in the Southern District of Indiana.
TRICARE is a health insurance system for members of the uniformed services and their families. It serves millions of beneficiaries, including many Hoosier families. Medicaid provides health coverage to millions of Americans, including low-income adults, children, pregnant women, the elderly, and people with disabilities. It is jointly funded by federal and state governments.
ABCA is a healthcare provider operating in multiple locations throughout the State of Indiana. It provides applied behavior analysis services to individuals with autism spectrum disorder. Sherry Michael is the founder and Chief Executive Officer of ABCA.
According to a settlement agreement between the United States, the State of Indiana, and ABCA, the government maintained that ABCA submitted false claims to the government through several fraudulent billing schemes. These schemes included submitting upcoded, concurrent, and duplicate claims, claims for services not covered by TRICARE, and claims already paid by third-party sources.
Specifically, ABCA submitted claims to TRICARE and Medicaid for Analyst and Technician services rendered concurrently to the same patient, on the same date of service, upcoded claims for services rendered by Technicians, and submitted claims for group therapy services when the services were not covered by TRICARE. ABCA also submitted claims to Medicaid for group therapy services improperly billed as direct one-on-one provider therapy and claims already paid by third-party sources, namely TRICARE and the Indiana CareSource marketplace, without indicating to Medicaid that the claims had already been paid.
Based on the investigation, the estimated loss to the Medicaid program was $348,194.60 and the estimated loss to TRICARE was $626,795.90. ABCA has agreed to pay $2,000,000 to the United States and the State of Indiana to resolve the government’s allegations, which includes double damages and some of the government’s investigative costs. This settlement is the largest TRICARE settlement ever collected in the Southern District of Indiana.
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Professionally Identified and joined WP August 26, 2013
DSM 5: Autism Spectrum Disorder, DSM IV: Aspergers Moderate Severity
“My autism is not a superpower. It also isn’t some kind of god-forsaken, endless fountain of suffering inflicted on my family. It’s just part of who I am as a person”. - Sara Luterman
Sorry for reviving this thread. Any more such cases recently?
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"A feller wiser than myself once said, sometimes you eat the bear, and sometimes the bear, well, he eats you."
The Stranger - The Big Lebowski
Your neurodiverse (Aspie) score: 140 of 200
Your neurotypical (non-autistic) score: 59 of 200
You are very likely neurodiverse (Aspie)
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