Psychiatrist, Husband Accused of Overbilling State Medicaid Program

A Westport psychiatrist, who had offices in Fairfield and New Haven, and her husband are accused of participating in an alleged long-running scheme to submit false claims to a state Medicaid program.

Attorney General George Jepsen announced Thursday that he has filed a complaint in Hartford Superior Court under the Connecticut False Claims Act seeking treble damages and other relief stemming from the scheme that took place from January 2010 through December 2014.

The complaint alleges that the co-owners of Brighter Concept, Inc. – Dr. Ashwini Sabnis, a licensed psychiatrist enrolled as a provider in the Connecticut Medical Assistance Program, and her husband, Saurav “Sam” Mohanty – participated in an elaborate and illegal scheme that resulted in the submission of false claims for services that were not provided, and claims that were “upcoded” — billed at a higher reimbursement code than warranted, according to a press release.

In addition, the complaint alleges that Sabnis and Mohanty knowingly attempted to conceal from the Department of Social Services (DSS), and the Attorney General, the existence of evidence that would have established the fraud.

“This action is being brought to seek damages, civil penalties and other relief due to a scheme that was perpetrated on a health care program intended to care for our most vulnerable citizens,” Jepsen said in a statement. “Health care providers who accept taxpayer dollars must play by the rules.”

According to the complaint, Sabnis and Mohanty illegally submitted false claims for reimbursement while knowingly retaining and concealing the overpayment. The defendants submitted, received and retained reimbursement totaling approximately $768,171 for psychiatric services allegedly provided to CMAP.

Sabnis is alleged to have engaged in a systemic practice of knowingly “upcoding” the claims for reimbursement she submitted to the CMAP.

For example, as the complaint alleges, Sabnis routinely scheduled her Medicaid patients for 15 or 30 minute appointments. However, her appointment records, which were obtained during the investigation, revealed that these appointments were often double, triple and in some cases, quadruple booked.

When submitting for reimbursement, the state’s lawsuit alleges that Sabnis consistently used a reimbursement code which required her to see the patient for approximately 75 to 80 minutes when, in fact, she saw the patient for as little as 5-10 minutes.

The state’s complaint identifies 113 days where Sabnis billed the CMAP for more than 24 hours of service.

Sabnis and Mohanty are also alleged to have attempted to conceal from DSS auditors the existence of databases that contained information which would have established evidence that the claims were false. The effort to conceal this information continued even after Jepsen began his investigation, according to the release.

The action is being brought under the Connecticut False Claims Act, which allows the state to seek relief including civil penalties, treble damages and the cost of investigation from anyone who knowingly submits false or fraudulent claims under a medical assistance program administered by DSS. DSS administers CMAP, which includes Medicaid and other programs that pay for medical benefits for certain low-income and disabled Connecticut residents.

The Attorney General’s investigation was initiated by a referral from the DSS’ Office of Quality Assurance, which conducted the initial inquiry of Sabnis’ billing conduct.