October 11, 2017

CT alleges fraud on Waterbury health provider

The state is suing a Waterbury mental-health services vendor for allegedly overbilling and using unlicensed practitioners to defraud the state's Medicaid program, authorities say.

State Attorney General George Jepsen and state Department of Social Services (DSS) Commissioner Roderick L. Bremby announced Wednesday the filing of a False Claims Act lawsuit against the provider, Elijah Caldwell.

Caldwell, the state said, is owner-operator of A Prospering Vision LLC and founder-president of nonprofit Home of Hope Inc., both in Waterbury.

Authorities say an arrest warrant was issued for Caldwell on charges of larceny and prescription-drug fraud.

Caldwell could not be immediately reached Wednesday for comment.

According to investigators, A Prospering Vision was enrolled in the state's Medicaid program – as a licensed behavioral health clinician group provider as well as for advanced practice registered nurse (APRN) group practice providers. Home of Hope, a one-year transitional housing program for homeless single women with children, was enrolled in the state Medicaid program as a behavioral health provider.

The state alleges in its lawsuit that, between March 2013 and last December, Caldwell regularly billed state Medicaid millions of dollars for services, many of which were never performed or were done by unlicensed individuals.

Known as "upcoding,'' the scheme involves a provider knowingly using a higher-paying code on the claim form for a state Medicaid recipient to reflect the use of a more expensive service, procedure or device than was actually used or was medically necessary.

"This case is particularly serious because it alleges both provider fraud against taxpayers and improper treatment of patients through uncredentialed individuals," Bremby said in a statement.

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