COLUMBIA — The state's largest provider of children's autism behavioral therapy has paid the federal government $8.8 million to settle a false claims probe, federal prosecutors have announced.
An official with Early Autism Project Inc. issued a statement Thursday that said the firm had agreed to pay the money "to allow us to continue our focus on providing life-changing applied behavior analysis therapy to children with autism spectrum and related disorders."
"We admit no wrongdoing and the corporate integrity agreement with the government clearly states that the terms apply to Early Autism Project only," said Sarah Vega, senior vice president of operations for Early Autism Project, in the statement.
The settlement resolves allegations that EAP billed a military insurance program, TRICARE, and South Carolina’s Medicaid program for ABA therapy services for children with autism that either misrepresented the services provided or where the services were not provided at all, federal prosecutors said.
An EAP-devised program, prosecutors alleged, was designed to maximize profits by billing Medicaid for administrative and management functions of the company. Medicaid does not pay for therapy services by individuals who are not actively working with the child for whom the therapy is billed.
Prosecutors also alleged that EAP allowed its therapists to regularly “pad” the hours it billed for therapy services to the TRICARE program and to South Carolina Medicaid, so that these programs regularly paid for therapy services that were not provided.
“Companies that commit to providing intensive behavioral treatment to children with autism, at a pivotal time of that child’s development, should be held accountable if they do not provide the services, but nevertheless request payment for those services,” said Barbara Bowens, acting United States attorney for the case and civil chief for the United States attorney’s office for the district of South Carolina.
According to prosecutors, the civil investigation arose from a lawsuit filed by a former employee of EAP, Olivia Zeigler, under the whistleblower provisions of the False Claims Act. Under the act, private citizens can bring suit on behalf of the government for false claims and share in any recovery. Zeigler will receive $435,000, according to federal prosecutors.
“That the State’s largest service provider for autistic children would defraud government health programs is compounded only by their billing at the expense of taxpayers for misrepresented or nonexistent services—as alleged here,” said Derrick L. Jackson, special agent in charge for the office of inspector general of the U.S. Department of Health and Human Services.
Early Autism Project, Vega said, has been cooperating fully with a government investigation of billing practices that were in place before EAP's parent company, ChanceLight, began operating EAP in 2013.
"Since then, we have been taking every possible action to ensure accuracy and compliance with all regulations," she said.
In addition to hiring outside experts who helped evaluate and enhance billing practices, the firm established a central bill office staffed by 26 credentialed medical billers, Vega said, It also created a compliance department to ensure compliance with all regulations regarding billing, and established a compliance hotline and website staffed by an independent third party to receive parent or employee concerns about billing practices.
As part of the settlement announced today, EAP, and ChanceLight, Inc. have also entered into a "corporate integrity agreement" with the U.S. Department of Health and Human Services, which seeks to ensure future corporate compliance by requiring internal compliance reforms, including hiring an independent review organization to conduct annual claims reviews, prosecutors said.
In a statement, Joshua D. Baker, director of the state's Medicaid agency, said his agency is committed to providing Medicaid benefits at the lowest cost to taxpayers.
"Unfortunately, our efforts have been hampered in recent years by the knowledge our largest applied behavior analysis (ABA) provider has operated as a coordinated criminal enterprise," he said, "fraudulently billing Medicaid and other payers for millions of dollars’ worth of services that were never provided. With this settlement, my hope is that the health care system for South Carolina’s children will continue to improve and we can continue to provide these important services."
