Pennsylvania Community Mental Health Clinics and Owners Agree to Voluntary Exclusions

PA 2018 Behavioral Health
OIG False Claims
Penalty
$0

Outcome

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Details

Pennsylvania Community Mental Health Clinics and Owners Agree to Voluntary Exclusions — Settlement

Outcome: Official websites use .gov A .gov website belongs to an official government organization in the United States.

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

On October 16, 2018, in connection with the resolution of their False Claims Act liability, Melchor Martinez (Martinez), Melissa Chlebowski (Chlebowski), Lehigh Valley Community Health Centers, Inc. (Lehigh Valley), Northeast Community Mental Health Centers, Inc. (Northeast), and Carolina Community Mental Health Centers, Inc. (Carolina), collectively ("MM"), agreed to be excluded from participation in all Federal health care programs under 42 U.S.C. § 1320a-7(b)(7). Martinez is presently excluded and agreed to be excluded for an additional 10-years. Chlebowski, Lehigh Valley, Northeast, and Carolina agreed to be excluded for 5 years. OIG alleged that MM submitted or caused to be submitted false claims to Medicare and Medicaid arising from: (1) Martinez's undisclosed management of Northeast, Lehigh Valley, and Carolina in violation of his exclusion from Federal health care programs; (2) Northeast's, Lehigh Valley's, and Carolina's use of unqualified and/or unsupervised mental health therapists; and (3) the submission and payment of Medicaid claims for medication management visits that were upcoded to reflect longer visits. Senior Counsel Nancy Brown represented OIG.

HHS Office of Inspector General

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Crucible's billing compliance controls enforce documentation-to-claims reconciliation, requiring clinical attestation before claims submission and flagging billing patterns that deviate from documented care delivery.

Source: Pennsylvania Community Mental Health Clinics and Owners Agree to Voluntary Exclusions

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