Tree of Life, Inc.

Philadelphia, PA 2014--2019 Behavioral Health

DOJ HHS-OIG Medicare Medicaid Fraud False Claims Act Anti Kickback Statute Phantom Billing Document Falsification

Penalty

$1.6 million

Outcome

Tree of Life, Inc. and its owners paid $1.65 million and agreed to permanent exclusion from federal healthcare programs to resolve False Claims Act and Anti-Kickback Statute allegations that they submitted thousands of fraudulent Medicaid claims for mental health therapy sessions that were never provided, including claims for patients who were hospitalized, deceased, or otherwise unavailable on the billed dates of service.

Details

Tree of Life, Inc. — Phantom Billing for Mental Health Services Never Rendered (2020)

Outcome: Tree of Life, Inc. and its owners, Ada and Victor Vidal, paid $1.65 million and accepted permanent exclusion from all federal healthcare programs to resolve False Claims Act and Anti-Kickback Statute allegations that they submitted thousands of fraudulent Medicaid claims for outpatient mental health therapy sessions that were never provided to patients.

Tree of Life, Inc. was an outpatient mental health clinic operating in Northeast Philadelphia, Pennsylvania. The clinic submitted claims to Pennsylvania Medicaid (Medical Assistance) for individual and group therapy sessions purportedly provided by licensed therapists and psychiatrists.

The fraudulent billing scheme involved multiple distinct categories of false claims. Tree of Life submitted claims for therapy sessions allegedly provided to patients who were admitted to inpatient hospital settings on the billed date of service and therefore could not have received outpatient therapy. Claims were also submitted for sessions allegedly delivered by therapists who had already left the clinic's employ at the time of the purported service. Additional claims were submitted for dates on which Tree of Life's office was confirmed to be closed. In the most egregious category, the clinic submitted claims for patients who had died before the alleged therapy session took place.

To support the fraudulent claims, Tree of Life fabricated clinical documentation, including forging the signatures of psychiatrists and therapists on patient progress notes and treatment plans. The forgery of licensed clinician signatures on clinical records constituted a separate violation of the Anti-Kickback Statute and Medicaid documentation requirements.

The case was announced in January 2020 by U.S. Attorney William M. McSwain for the Eastern District of Pennsylvania. Tree of Life ceased operations effective December 31, 2019, prior to the settlement announcement. As a result of the resolution, Ada and Victor Vidal were permanently excluded from participation in Medicare, Medicaid, and all other federal healthcare programs.

Primary Source: United States Obtains $1.65 Million Resolution for Fraudulent Medicaid Billing Against Behavioral Health Clinic in Northeast Philadelphia — DOJ Eastern District of Pennsylvania

How Crucible Prevents This

Crucible claims integrity controls with cross-reference against patient hospitalization records, discharge data, and mortality data would detect claims submitted for dates on which the patient was demonstrably unavailable. A signature verification module flagging forged clinician attestations would catch falsified progress notes and treatment plans. Encounter-to-calendar reconciliation logic would surface claims submitted on dates when the facility was officially closed. OIG exclusion screening against all billing staff and owners would prevent the use of sanctioned individuals in Medicaid billing.

Source: United States Obtains $1.65 Million Resolution for Fraudulent Medicaid Billing Against Behavioral Health Clinic in Northeast Philadelphia — DOJ Eastern District of Pennsylvania

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