State Joins $2.7 Million National Settlement with Pediatric Services of America, Inc. to Resolve Overcharging Allegations

Attorney General George Jepsen, Chief State’s Attorney Kevin T. Kane and state Department of Social Services (DSS) Commissioner Roderick L. Bremby announced today that Connecticut has joined a federal-state settlement with Pediatric Services of America Inc. (PSA) to resolve allegations that the company inappropriately failed to return overpayments received from state Medicaid programs as well as other federally insured health programs. PSA is also alleged to have overcharged for home nursing services by improperly rounding-up claims to the nearest whole hour. The Georgia-based pediatric and home-care company has agreed to pay the states and the federal government $2.7 million.

The states alleged that PSA knowingly failed to return overpayments that it received from state Medicaid programs on claims submitted to state Medicaid programs between January 2007 and June 2013. PSA is also alleged to have created a billing system that double rounded minutes employees worked, which would create an overcharge to states’ Medicaid programs and overstate the length of time services were provided.

The companies agreed to pay the states and the federal government $2,773,007 to resolve the civil allegations. The portion of the settlement attributable to the state and federal shares of Connecticut’s Medicaid program is $264,689.58, of which $153,998.08 represents the net state share. As part of the settlement, PSA has also agreed to enter into a Corporate Integrity Agreement with the United States Department of Health and Human Services, Office of the Inspector General, which will closely monitor future marketing and sales practices of the company.

“Improper and fraudulent billing claims against our Medicaid program will not be tolerated,” said Attorney General Jepsen. “We take allegations of fraud and abuse very seriously, and we will continue to work to hold accountable those who seek to defraud and overcharge our taxpayers. I thank the Chief State’s Attorney and the Department of Social Services for their continued partnership in these matters.”

Chief State’s Attorney Kane commended the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney, the Office of the Attorney General and the Department of Social Services for their continued efforts to recover scarce public resources and protect the integrity of the Medicaid program.

DSS Commissioner Roderick L. Bremby said, “This settlement exemplifies the outstanding work across the state and federal governments to obtain compensation for the taxpayer-funded Medicaid program when medical providers cross the line. While the great majority of Connecticut Medicaid providers are above-board, this case again demonstrates the need for vigilant anti-fraud enforcement. We thank the Attorney General’s Office, the Chief State's Attorney's Office and our other partner agencies for their outstanding work in this key area.”

Anyone with knowledge of suspected fraud or abuse in the healthcare system is asked to contact the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney at 860-258-5986 or by email at conndcj@ct.gov; the Attorney General’s Antitrust and Government Program Fraud Department at 860-808-5040 or by email at ag.fraud@ct.gov; or the DSS fraud reporting hotline at 1-800-842-2155 or by email at providerfraud.dss@ct.gov.

Please click here to view the settlement documents.

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