Ind. U.S. Attorney's Office Recovers $2M From Autism Therapy Provider for Alleged False Healthcare Claims in District's Largest TRICARE Settlement

INDIANAPOLIS, Indiana, Feb. 11 -- The office of the U.S. Attorney for the Southern District of Indiana issued the following news release on Feb. 10, 2023:

The United States Attorney's Office for the Southern District of Indiana has recovered $2,000,000 for taxpayers as part of a civil settlement with an Indiana autism therapy provider, ABA Programming Inc., Applied Behavior Center for Autism, and its owner, Sherry Michael ("ABCA"). ABCA is a provider of applied behavior analysis services for clients with autism throughout Indiana. The settlement will resolve allegations that ABCA submitted false claims to the TRICARE and Indiana Medicaid programs.

TRICARE is a health insurance system for members of the uniformed services and their families. It serves millions of beneficiaries, including many Hoosier families. Medicaid provides health coverage to millions of Americans, including low-income adults, children, pregnant women, the elderly, and people with disabilities. It is jointly funded by federal and state governments.

ABCA is a healthcare provider operating in multiple locations throughout the State of Indiana. It provides applied behavior analysis services to individuals with autism spectrum disorder. Sherry Michael is the founder and Chief Executive Officer of ABCA.

According to a settlement agreement between the United States, the State of Indiana, and ABCA, the government maintained that ABCA submitted false claims to the government through several fraudulent billing schemes. These schemes included submitting upcoded, concurrent, and duplicate claims, claims for services not covered by TRICARE, and claims already paid by third-party sources.

Specifically, ABCA submitted claims to TRICARE and Medicaid for Analyst and Technician services rendered concurrently to the same patient, on the same date of service, upcoded claims for services rendered by Technicians, and submitted claims for group therapy services when the services were not covered by TRICARE. ABCA also submitted claims to Medicaid for group therapy services improperly billed as direct one-on-one provider therapy and claims already paid by third-party sources, namely TRICARE and the Indiana CareSource marketplace, without indicating to Medicaid that the claims had already been paid.

The resolution obtained in this matter was the result of a coordinated effort between the Department of Defense - Office of the Inspector General ("DOD-OIG"), Department of Health and Human Services - Office of the Inspector General ("HHS-OIG"), the Indiana Attorney General's Medicaid Fraud Control Unit ("Indiana MFCU"), the Federal Bureau of Investigation ("FBI"), in coordination with the United States Attorney's Office.

Based on the investigation, the estimated loss to the Medicaid program was $348,194.60 and the estimated loss to TRICARE was $626,795.90. ABCA has agreed to pay $2,000,000 to the United States and the State of Indiana to resolve the government's allegations, which includes double damages and some of the government's investigative costs. This settlement is the largest TRICARE settlement ever collected in the Southern District of Indiana.

"Waste, fraud, and abuse in healthcare claims wrongfully take funds intended to provide needed care to our military and Medicaid families," said Zachary A. Myers, United States Attorney for the Southern District of Indiana. "Behavioral services providers must not exploit the needs of patients and families living with autism spectrum disorder to claim public funds to which they are not entitled. Our office is committed to working with our partners with the Department of Defense, the Department of Health and Human Services, and the Indiana Attorney General's Medicaid Fraud Control Unit to protect taxpayer money and ensure that providers comply with the law."

"Health care providers who seek to defraud TRICARE and profit at the expense of patients under their care, particularly those with special needs, should be held fully accountable," stated Special Agent in Charge Darrin K. Jones, Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Southeast Field Office. "Today's settlement demonstrates the commitment of DCIS, along with our partners, to safeguard critical resources for the health and well-being of our military members, their families, and retirees, who deserve the best care available."

"Behavioral analysis services for children, and other Medicaid beneficiaries, are of crucial importance to our communities," said Special Agent in Charge Mario M. Pinto of the U.S. Department of Health and Human Services, Office of the Inspector General (HHS-OIG). "Our office is committed to working together with our law enforcement partners to hold those to account for fraud in these, and other, Federal health care programs."

"These programs are designed to help our most vulnerable Hoosiers," Attorney General Todd Rokita said. "Parents and families across the state rely on the aid of autism therapy providers to better care for their loved ones. By submitting false claims, the Applied Behavior Center for Autism deprived low-income families, disabled people, and pregnant mothers of adequate funding. We are fighting back to ensure taxpayers are protected and the Medicaid funds are being used to benefit those in need."

U.S. Attorney Myers thanked Assistant U.S. Attorney Justin Olson, who prosecuted this case.

The claims resolved by this settlement are allegations only. There has been no determination of liability. In agreeing to the settlement terms, ABCA denied all liability under the False Claims Act. In investigating the case, HHS-OIG, DOD-OIG, and MFCU did not uncover any evidence of injury or harm to patients as a result of the alleged conduct.

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Original text here: https://www.justice.gov/usao-sdin/pr/us-attorneys-office-recovers-2-million-autism-therapy-provider-alleged-false