Waterford psychologist Arlene Werner, owner of a private psychotherapy practice, has paid more than $126,000 to the state and federal governments to resolve charges that she billed Medicaid for services that were not provided.

United States Attorney John H. Durham, Connecticut Attorney General George Jepsen and state Department of Social Services Commissioner Roderick L. Bremby announced Tuesday that Werner entered into a civil settlement agreement with the federal and state governments and made the $126,000 payment to resolve allegations that she violated the federal and state False Claims acts.

The two governments alleged that between January 2011 to July 18, 2016, Werner billed Medicaid for psychotherapy services that were not provided and that she billed Medicaid for family psychotherapy sessions for multiple family members — a service with the highest reimbursement rate — when she should have billed one family member for individual psychotherapy services.

Under the agreement, Werner has been suspended from participation in the Connecticut Medical Assistance Program (CMAP) – which includes the state's Medicaid program – for a period of two years.

Of the settlement funds, $76,056.05 represents the state's share and will be returned to the CMAP; the remainder of the settlement funds will be remitted to the federal government, according to Jepsen. He said in a press release that Werner was engaged in a practice known as "upcoding," which is when a provider knowingly submits claims for a higher-reimbursed procedure code on a claim form that reflects the use of a more expensive service, procedure or device than was actually used or was medically necessary.

"My office will continue to vigorously pursue those who seek to defraud our public health care programs," said Jepsen. "I am grateful to our federal law enforcement partners and to Connecticut's U.S. Attorney for their continued coordination in investigating and prosecuting False Claims Act violations."

"This case is another example of the outstanding work by state and federal partners involved in anti-fraud oversight of the Medicaid program," said Commissioner Bremby. "I join Attorney General Jepsen in thanking the dedicated professionals who took part in this investigation and resulting settlement to recoup public funding."

The investigation was initiated by a fraud referral from the DSS Office of Quality Assurance's Special Investigations Unit and was conducted jointly with the state's Medicaid Fraud Control Unit (MFCU) and U.S. Health and Human Services, Office of Inspector General – Office of Investigations (HHS-OIG-OI).

"It is imperative that providers accurately bill Medicaid and other insurance programs," said U.S. Attorney Durham. "Working with our federal and state partners, we will continue to protect the integrity of the Medicaid program to ensure its recipients receive the healthcare services they need."

Under the False Claims Act, the government can recover up to three times its actual damages, plus penalties of $11,181 to $22,363 for each false claim.

This case stems from a larger investigation into fraudulent activity in the area of behavioral health services, which has been jointly conducted by the Office of the Inspector General of the U.S. Department of Health and Human Services, the Medicaid Fraud Control Unit of the Chief State's Attorney's Office, and the Connecticut Office of the Attorney General. 

The case was handled by Assistant U.S. Attorney Anne Thidemann and Assistant Attorney General Antonia Conti of the Connecticut Office of the Attorney General.

People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.