New London psychiatrist to pay $3.3 million for overbilling of urine drug screen tests
New London area psychiatrist Dr. Bassam Awwa, and his medical practice, Connecticut Behavioral Health Associates, have agreed to pay a $3.3 million settlement to the federal and state governments for overbilling Medicare and Medicaid for drug and alcohol urine tests.
U.S. Attorney John H. Durham announced Friday that Awwa and his practice, known as CBHA, entered into a civil settlement agreement in which they will pay $3,382,004 to resolve allegations that they violated the federal and state False Claims Acts.
The practice, which operates out of 11 locations and provides behavioral health and addiction services to Medicare and Medicaid patients, routinely conducts urine drug screening tests on patients. Though the urine is tested for multiple classes of drugs and alcohol, Medicare considers it a single test that should be billed only once per patient encounter, according to the government.
The government alleges Awwa and CBHA submitted claims to Medicare for multiple units of urine drug screening tests, when they knew or should have known that only one unit of service could be billed per patient encounter.
In addition, the government alleges the practice submitted claims to Medicare for alcohol tests conducted on patient urine samples that they know or should have known were a component of the urine drug screening test for which Awwa and the practice were already being paid by Medicare.
Finally, the government alleges Awwa and CBHA defrauded the Connecticut Medicaid program by submitting claims for definitive urine drug tests (also known as "quantitative" or "confirmation" tests) that were not actually performed, and by improperly submitting claims to Medicaid for specimen validity testing of urine samples.
The settlement covers claims submitted to the Medicare program from Jan. 1, 2011 to Dec. 31, 2015, and claims submitted to the Medicaid program from April 1, 2013 to March 31, 2016.
White Plains, N.Y. attorney Pat Bonanno, who negotiated the settlement on behalf of Awwa and CBHA, said that unfortunately, the practice did not adhere to the mandated coding and billing changes during the period the government claims there was overbilling.
"It was really an administrative error on behalf of CBHA and Dr. Awwa," Bonanno said by phone Friday afternoon. "It was no intentional misuse of the funds by Dr. Awwa."
Under the law, triple damages are required in false claims, Bonanno said. The government claimed Awwa and the practice overbilled Medicare and Medicaid by approximately $2.1 million and were exposed to over $6 million in liability, Bonanno said. He said the federal and state officials negotiated the settlement in a professional manner.
There was no claim that Awwa abused his authority as to his ability to practice medicine, and part of the agreement is that there would be no punitive action against his license. Bonanno said there is no insurance company involved, and it would be up to Awwa and the practice to pay the settlement.
"He's well respected in the profession," Bonanno said of Awwa. "This took him back personally, but he ultimately realized there were administrative errors beyond his control. We've put into position facilities and procedures that will allow us to keep a tighter control of that."
As part of the settlement, AWWA and CBHA have entered into a three-year billing Integrity Agreement with the U.S. Department of Health and Human Services that is designed to ensure future compliance with the requirements of federal health care programs.
"It is alleged that, for years, these defendants recklessly overbilled Medicare for drug screening tests," said U.S. Attorney Durham. "Medical practices and physicians who treat patients for substance abuse must bill their services accurately and honestly, and health care providers who submit false claims to federal health care programs will be held accountable."
"It is critically important that we protect federal health care programs upon which millions of people rely," said Special Agent in Charge Phillip Coyne of the U.S. Department of Health and Human Services, Office of Inspector General. "Thus, we will hold accountable providers who submit false claims to Medicare and receive payments to which they are not entitled."
"Providers enrolled in the Connecticut Medicaid program are expected and trusted to bill the program accurately and honestly," said Connecticut Attorney General William Tong. "For years, the defendants betrayed that trust and overcharged the Medicaid program for certain services they provided to Medicaid recipients. This settlement holds those who defrauded this taxpayer-funded program accountable. I want to thank the Connecticut Department of Social Services' Office of Quality Assurance for assisting with this matter and for their continued efforts in combatting health care fraud."
The case was investigated by the Office of Inspector General for the Department of Health and Human Services, the Federal Bureau of Investigation, the U.S. Postal Service, Office of Inspector General, and the Department of Defense, Office of Inspector General. The case is being prosecuted by Assistant U.S. Attorney Richard M. Molot, and Assistant Attorney General Gregory O'Connell 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.
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