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Healthcare Provider In Fairfield County Ordered To Pay $354K For Improper Billing

Recovery Network of Programs in Stratford
Recovery Network of Programs in Stratford Photo Credit: Recovery Network of Programs

A healthcare organization that provides substance abuse and mental health services in Fairfield County, has agreed to pay more than $350,000 in restitution for overcharging for certain services.

U.S. Attorney John Durham said that Recovery Network of Programs Inc. (RNP) has entered into a civil settlement with the government to pay $354,367 to resolve allegations that it caused overpayments for urine drug testing services to be paid by the Connecticut Medicaid Program.

RNP provides behavioral health and substance use disorder services to Medicaid beneficiaries.

An audit by the State of Connecticut Department of Social Services (DSS) found that Recovery Network of Programs and an independent laboratory both billed Medicaid for drug testing performed by the lab, contrary to the department’s weekly rate payment regulations. 

Durham said that in January 2016, DSS issued an Audit Report warning RNP that continued non-compliance with the weekly rate payment rule would result in financial disallowances in future audits.

It is alleged that “despite clear guidance from the Medicaid program and the audit finding indicating that on-site drug testing was part of the bundled rate, RNP continued to refer urine drug tests for patients to an outside, independent laboratory.” 

As a result, Medicaid paid for the claims twice, once to RNP, and a second time to the outside laboratory.

Durham said: “Overbilling of Medicaid and other government health insurance programs cannot be tolerated and providers who fail to follow the rules, especially after multiple warnings, face serious consequences.” 

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