Company, CEO Pay Nearly $4.6M To Settle Telehealth Fraud Accusations: Feds

CONNECTICUT — A behavioral health company and its CEO will pay nearly $4.6 million to settle telehealth billing fraud accusations, according to officials.

Supportive Care Holdings, LLC, its related healthcare companies doing business in Connecticut and other states, and its CEO, Joseph “Dov” Newmark, have entered into a civil settlement agreement with the federal government and paid $4,595,739 to resolve allegations that they fraudulently and improperly submitted claims to Medicare and Connecticut Medicaid related to telehealth services provided to nursing home residents, U. S. Attorney for Connecticut Vanessa Roberts Avery announced Thursday in a joint news release with Roberto Coviello, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of the Inspector General.

The related health care companies provide, among other things, psychological services to patients residing in skilled nursing facilities in Connecticut and other states. Newmark is the CEO for each of the Supportive Care Companies.

“The government’s allegations against the Supportive Care Companies and Newmark involve improper and false claims submitted for ‘telehealth originating site facility fees,’” according to the news release. “A telehealth visit involves an exchange between a patient at an originating site (e.g. a nursing home) and a physician, or other qualified healthcare professional, at a distant site. Relevant billing rules and guidance, specifically Healthcare Common Procedure Coding System (HCPCS) code Q3014, allows payment for a ‘telehealth originating site facility fee’ in addition to the professional fee for the underlying psychological service being provided. However, HCPCS code Q3014 should only be billed by the originating site (in this case, the nursing homes) when the facility provides administrative and clinical support for a patient receiving services via telehealth. The government alleges that the Supportive Care Companies and Newmark submitted or caused to be submitted improper and false claims for “telehealth originating site facility fees,” billed pursuant to HCPCS code Q3014, which should only have been billed by the nursing homes.”

Read more from the news release below:

In addition, the government alleges that the Supportive Care Companies and Newmark submitted or caused to be submitted false or fraudulent claims for payment to Medicare and Connecticut Medicaid for psychological services allegedly provided to Medicare and Medicaid beneficiaries residing in nursing homes when those Medicare and Medicaid beneficiaries were not, in fact, residing in the nursing homes, but had been transferred to various hospitals and admitted as inpatients.

The settlement resolves False Claims Act and common law allegations for conduct occurring between 2019 and 2023.

“As telehealth plays an increasingly important role in our health care system, it is critical that health care providers follow the relevant rules and bill for such services accurately and honestly,” Avery said. “The U.S. Attorney’s Office will vigorously investigate and enforce the law against any provider that submits fraudulent claims related to telehealth services, as this misconduct increases the cost of health care for all of us.”

Coviello said, “Our federal health care system relies on the basic principle that providers bill properly and follow the rules, and the taxpayers who fund the Medicare and Medicaid programs deserve nothing less. We are committed to protecting the integrity of those programs, and we will continue to pay particular attention to schemes that seek to undermine the legitimate delivery of telehealth services.”

The matter was investigated by the U.S. Department of Health and Human Services, Office of Inspector General. The case was prosecuted by Assistant U.S. Attorney Richard M. Molot.

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.