[MM Curator Summary]: Springbok Health will pay up to $335k for upcoding simple services to get paid as if they were complex medical services.
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A substance abuse treatment clinic in Pueblo West has agreed to pay at least $125,000 to resolve allegations by the Colorado U.S. Attorney’s Office that it violated the False Claims Act by billing Medicare and Medicaid for complex medical services that were never rendered.
Springbok Health Inc., a clinic with locations in Colorado Springs and Pueblo West, and its owner and CEO Mark Jankelow, agreed to pay at least $125,000 and as much as $335,494 in the settlement, the Colorado U.S. Attorney’s Office said in a statement.
The claims settled by the agreement are allegations only, according to the U.S. Attorney’s Office, and do not reflect a determination of liability. The resolution is based on Springbok’s and Jankelow’s ability to pay.
From 2017 to 2019, Springbok allegedly billed Medicare and Medicaid for “expensive medical evaluation and management services when, at most, less expensive counseling services were provided,” the statement said.
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“Billing Medicare and Medicaid for more expensive services than were actually rendered depletes the limited resources of these vital health care programs,” Principal Deputy Assistant Attorney General Brian M. Boynton said in the statement. “We will continue to safeguard taxpayer dollars and hold accountable those who knowingly misuse such funds.”
“Providing substance abuse treatment is a vital tool in combating the opioid epidemic devastating Colorado communities,” said U.S. Attorney Cole Finegan for the District of Colorado. “But offering treatment to addicts does not excuse fraud. Our office will continue to pursue claims against providers whose fraudulent billing practices take valuable resources away from victims of the opioid crisis.”
The False Claims Act, which Springbok and Jankelow were accused of violating, is a federal law that imposes liability on companies and individuals who defraud governmental programs. It dictates that violators are liable for treble damages — damages up to three times actual or compensatory damages awarded to a prevailing plaintiff — plus a penalty that is linked to inflation.
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In addition to allowing the U.S. government to pursue perpetrators of fraud, the FCA allows private citizens to file suits on behalf of the government in “qui tam” suits against those who have defrauded the government.
Private citizens who successfully bring qui tam actions may receive a portion of the government’s recovery.
The civil settlement with Springbok includes the resolution of an action brought under the qui tam or whistleblower provisions.
The citizen who brought the action, identified in the U.S. Attorney’s Office statement only as “Ms. Chaudhry,” will receive at least $22,500, and up to $60,389 as her share of the settlement.
Springbok and Jankelow could not be reached for comment by The Chieftain’s press deadline Tuesday.
Chieftain reporter Zach Hillstrom can be reached at zhillstrom@gannett.com or on Twitter @ZachHillstrom