Attorney General Tong announces $739,759 settlement with Manchester Pediatric Associates over false Medicaid billing
(Hartford, CT) — Attorney General William Tong today announced a $739,759.52 Connecticut False Claims Act settlement with Manchester Pediatric Associates, LLC (MPA), and its owner, Dr. Swathanthra Melekote to resolve allegations that MPA made false and fraudulent claims between January 2015 and May 2021, resulting in overbilling of the Connecticut Medicaid program.
“Over the course of more than five years, Manchester Pediatric Associates and its owner Dr. Melekote knowingly and systematically submitted hundreds of thousands of dollars in false claims to the Medicaid program for services he failed to provide to maximize his own profits. These false claims and fraudulent dual billing practices misused Connecticut Medicaid funds intended for the medical care of our state’s most vulnerable residents.” Attorney General Tong said. “The Office of the Attorney General takes our responsibility to protect our public health care programs seriously and is prepared to take firm action against anyone who violates that public trust.”
“These unforgivable violations of the False Claims Act have resulted in a large settlement amount being returned to the Medicaid program,” Department of Social Services Commissioner Deidre S. Gifford said. “While such violations do not represent Medicaid providers as a whole, the case underscores the continued need for strong enforcement of public integrity standards. I thank the Attorney General and his staff, our DSS Anti-Fraud Investigators, and all of the partners who are working to secure taxpayer investment in our health coverage programs.”
Manchester Pediatric Associates serves approximately 5,700 pediatric Medicaid patients in South Windsor, Torrington and Tolland. Following a whistleblower’s complaint, the Attorney General’s office has partnered with the Department of Social Services’ Special Investigations Department to investigate Melekote’s questionable billing practices.
The investigation — which included a review of claims data for MPA Medicaid patients’ medical records, as well as extensive interviews with current and former MPA employees — found that Melekote violated the Connecticut False Claims Act by knowingly billing Medicaid twice for maternal screening. depression and vaccine administration and by “up-coding” to bill medical services as if a physician had provided the services, rather than a physician’s assistant or nurse practitioner, who would have been reimbursed at a lower rate. Melekote also charged Medicaid for maternal depression screening after a patient was one year old and without adequate documentation of the service being provided in the patient’s medical records.
The investigation also found that Melekote instructed staff to add numerical “modifiers” to the codes entered on the electronic claim for payment for a service that MPA submitted to DSS’s claims processor. This was how MPA was able to “pay double bill” for a single maternal depression screen or single vaccine administration. MPA employees were told to bill based on a “billing guide” prepared by Melekote, regardless of whether the billed services were in the patient’s medical record, and whether a middle-ranking physician rather than a physician provided the service. granted.
The total settlement amount is $739, 759.52 and will be paid no later than December 30, 2021.
Anyone with knowledge of suspected fraud or abuse in the public health care system is requested to contact the Attorney General’s Department of Antitrust and Government Program Fraud at 860-808-5040 or by email at firstname.lastname@example.org; or the Department of Social Services Fraud Hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud, or by email at email@example.com.
Assistant Attorney General Karla Turekian, Forensic Fraud Investigator Lisa Bailey, Forensic Fraud Investigator Tom Martin and Paralegal Orlean Woodham, and Department Head of Antitrust and Government Program Fraud, Jeremy Pearlman, have assisted the Attorney General in this case.
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