U.S. Attorney David C. Weiss announced today that the United States has filed a complaint in partial intervention against Connections Community Support Programs, Inc. ("Connections") in the United States District Court for the District of Delaware. The United States alleges that Connections violated the False Claims Act by knowingly submitting claims for payment to Medicare and Medicaid that falsely represented the identity and professional qualification of individuals providing mental health services.

Connections provides mental health treatment services at facilities located throughout Delaware. Medicare regulations and policies only allow providers to bill for mental health services rendered by individuals holding specific professional qualifications. Delaware Medicaid regulations and policies similarly condition whether mental health services can be reimbursed, and at which fee rate, on the professional qualification of the rendering provider.

The United States alleges that from at least January 2015 through October 2019, Connections submitted over 4,000 claims to Medicare in which it falsely certified that an individual holding an eligible qualification provided mental health services to Medicare beneficiaries when, in reality, a different Connections staff member who did not hold an eligible qualification provided the mental health service. With respect to Medicaid, the United States alleges that Connections submitted over 250,000 false claims that resulted in either full or partial overpayments due to Connections falsely certifying to the licensure or education level of the rendering provider. As a result of the false claims Connections submitted to Medicare and Medicaid, the United States alleges that Connections was paid more than $4,500,000 for mental health services for which it was not entitled to reimbursement.

"Federal healthcare regulations and policies that govern mental health services exist to ensure that Medicare and Medicaid beneficiaries are treated by qualified professionals," said U.S. Attorney Weiss. "We expect all providers to submit claims that are true, accurate, and complete, and entrust that they will do so. Connections violated that trust, and in the process, defrauded Medicare and Medicaid out of more than $4.5 million dollars. My office is committed to pursuing all providers who submit false claims to federal healthcare programs to obtain money to which they are not entitled."

The original complaint was filed in 2019 under the qui tam or whistleblower provisions of the False Claims Act, which allow private parties to file suit on behalf of the United States for false claims and receive a share of any recovery. The act permits the United States to intervene in whole or in part in such actions, as the government has done here. Those who violate the Act are subject to treble damages and applicable penalties.

The matter is being investigated by the U.S. Department of Health and Human Services Office of Inspector General and the Delaware Medicaid Fraud Control Unit. The investigation and litigation are being handled by Assistant U.S. Attorneys Laura D. Hatcher and Jesse S. Wenger.

The claims asserted by the United States are allegations only and there has been no determination of liability.

A copy of this press release may be found on the website of the U.S. Attorney's Office for the District of Delaware. Related court documents and information is located on the website of the District Court for the District of Delaware or on PACER. The case is captioned United States ex rel. Spruill et al. v. Connections Community Support Programs, Inc., Case No. 19-475-CFC (D. Del.).