CT Pediatric Practice Gets Heavy Fine In Fraud Settlement

HARTFORD, CT — A pediatric practice with two offices in north central Connecticut has been ordered to pay a hefty fine.

State Attorney General William Tong Thursday announced a $700,000-plus Connecticut False Claims Act settlement with Manchester Pediatric Associates and its owner, Dr. Swathanthra Melekote, to resolve allegations that MPA submitted false and fraudulent claims between January 2015 and May 2021 that resulted in over-billing 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 of false claims to the Medicaid program for services he did not perform to maximize his own profit. These false claims and fraudulent double billing practices misused Connecticut Medicaid resources intended for the medical care of our state’s most vulnerable residents," Tong said. "The Office of the Attorney General takes seriously our responsibility to safeguard our public healthcare programs and is prepared to take strong action against anyone who violates that public trust."

Department of Social Services Commissioner Deidre S. Gifford called the case "inexcusable violations."

She added, "While such violations do not represent Medicaid providers as a whole, the case underscores the continuing need for strong enforcement of public integrity standards. I thank the attorney general and his staff, our DSS anti-fraud investigators, and all partners who work to safeguard taxpayer investments in our health coverage programs.”

Tom said Manchester Pediatric Associates serves about 5,700 pediatric Medicaid patients in South Windsor, Torrington, and Tolland.

Following a whistleblower complaint, the Office of the Attorney General worked with the Department of Social Services Special Investigations Unit to conduct an investigation into what he called 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 CT False Claims Act by "knowingly billing Medicaid twice for maternal depression screenings and vaccine administration and by up-coding to bill for medical services as if a physician had provided the services, instead of a physician assistant or nurse practitioner, which would have been reimbursed at a lower rate," Tong said.

Melekote also billed Medicaid for maternal depression screens after a patient was a year old, and without adequate documentation that the service was provided in the patient’s medical records, Tong said.

The investigation also found that Melekote directed staff to attach numerical "modifiers" to the codes entered on the electronic claim for payment for a service that MPA submitted to DSS’s claims processor, Tony said.

He added, "This was how MPA was able to double bill for a single maternal depression screen or single vaccine administration. MPA employees were told to bill from a billing guide created by Melekote without regard to whether the billed services were in the patient’s medical record, and without regard to whether a mid-level practitioner rather than a physician provided the service."

The total settlement amount is exactly $739, 759.52 and will be paid no later than Dec. 30, according t0 Tong.