A Tolland psychiatrist will pay $404,798 to settle a civil False Claims Act lawsuit alleging she submitted false claims for payments to Connecticut’s Medicaid program, according to a news release from Attorney General George Jepsen.
The resolution stems from a lawsuit and settlement agreement approved Monday by a Hartford Superior Court judge, Jepsen said.
The attorney general alleged that, while enrolled as a behavioral health and psychiatric services provider in the Connecticut Medical Assistance Program (CMAP), Dr. Leela A. Panoor submitted “upcoded” claims to the state Department of Social Services (DSS) for services provided to her Medicaid patients.
“Upcoding” occurs when a provider knowingly uses a higher-paying code on the claim form for a CMAP recipient to reflect the use of a more expensive service, procedure or device than was actually used or was medically necessary.
The state alleged that from March 2010 to September 2013, while operating a private practice in Mansfield, Panoor submitted upcoded claims indicating she provided Medicaid patients with both group counseling and either individual psychotherapy or a detailed examination on the same dates of service. In fact, she did not provide psychotherapy or detailed examination sessions, but instead provided medication management services or a brief meeting with the patient for the purpose of monitoring or changing a patient’s drug prescription – services that are coded, and thus reimbursed, at lower payment rates, the release said.
Panoor agreed to pay $404,798 to the CMAP to resolve the False Claims Act allegations and has entered into a separate agreement with DSS that restricts her participation in CMAP to services provided as a performing provider employed by or contracted with an organization.
