A Newtown psychiatrist has agreed to a $422,641.70 joint federal-state settlement and will enter into a compliance program to resolve allegations that he submitted false claims for payments to Connecticut’s Medicaid program and to Medicare, Attorney General George Jepsen announced today.
Jepsen alleged that, while enrolled as a behavioral health and psychiatric services provider in the Connecticut Medical Assistance Program (CMAP), Dr. Naimentulla Syed knowingly submitted “upcoded” claims to the state Department of Social Services (DSS) for services provided to his Medicaid patients, according to Jepsen’s office.
The practice of “upcoding” occurs when a provider knowingly uses a higher-paying code on the claim form for a CMAP recipient to reflect a more expensive service, procedure or device than was actually used or was medically necessary.
The state alleged that, from July 2009 through Dec. 2013, while operating a private practice, Syed submitted upcoded claims indicating that he provided Medicaid and Medicare patients with 45 minutes or more of face-to-face psychotherapy and a medical evaluation and management service when, in fact, he had provided 30 minutes or less of therapy and no evaluation and management service, the release said.
Under terms of the settlement, Syed did not admit liability but has agreed to a cash payment of $401,865.71 to the state and federal governments to resolve the False Claims Act allegations and will forfeit an additional $20,775.99 in funds the state withheld paying while its investigation was pending. The state’s share of the settlement proceeds is $185,830.66.
Additionally, Syed will implement a compliance program intended to prevent fraud and will be required to report to the AG on his compliance annually for three years.
