US Attorney, RI Attorney General File Complaint Alleging Millions of Dollars of Medicaid Fraud
Federal and State Governments Sue Local Substance Abuse Counselling and Treatment Provider for
Allegedly Billing Medicaid for Services That Were Not Provided
PROVIDENCE, R.I. – The United States and the State of Rhode Island announced today that they have intervened in a civil lawsuit against Journey to Hope, Health, and Healing, Inc. and its then-CEO, Kenneth L. Richardson, Jr., filing a complaint alleging that these defendants billed the Rhode Island Medicaid program for millions of dollars for substance use disorder treatment services that the Defendants knowingly and routinely failed to provide to their patients who needed these services, and subsequently falsified records in order to make it appear that required services were being provided, according to United States Attorney Zachary A. Cunha and Rhode Island Attorney General Peter F. Neronha.
The Complaint in Intervention, filed under the federal and Rhode Island state False Claims Acts and other theories of civil liability unsealed by a federal judge late this afternoon, lays out the governments’ allegations that Journey, despite holding itself out as a certified and accredited opioid treatment provider, routinely failed to provide treatment plans and adequate counseling for patients for whom they were providing methadone, while at the same time collecting over $15 million from the federal-and-state-administered Medicaid program during the period between January 2015 and July 2021. The complaint further alleges that in preparation for upcoming reviews by accreditation officials and other auditors, Journey personnel were instructed by management to falsify records in order to make it appear that the missing services had been provided. The United States and the State of Rhode Island allege that over half of amount claimed by Journey during this time period was false, and the government is seeking to recover up to three times the amount paid as a result of the alleged false claims, plus penalties.
As alleged in the governments’ complaint, in many cases, Medicaid beneficiaries were receiving methadone from Journey for years without any required individualized treatment plan in place, and that in some cases where plans did exist, they were not updated for years. Journey is further alleged to have failed to provide increased services or attention to patients who tested positive for illicit substances, including fentanyl, and to have maintained patient caseloads for counselors at a volume so high that it was physically impossible to offer required counselling services. Finally, the company is alleged to have altered and backdated documents in order to make it appear that updated individualized treatment plans were in place and that the required counseling sessions were occurring when, in fact, they were not.
Whistleblowers Sara Quaresma and Michael Delmonico, who are former employees of Journey, filed an action in federal court in October of 2020 under the qui tam provisions of the False Claims Act. Those provisions authorize private parties to sue on behalf of the United States and/or the State and to share a portion of any recovery; such a filing is initially made under seal. The Act permits federal and state governments to intervene and take over the lawsuit, as has occurred here, in part, by filing this complaint in intervention. The case was unsealed on Monday following the governments’ filing.
The case is being litigated in U.S. District Court by Assistant U.S. Attorneys Bethany N. Wong and Kevin Love Hubbard, and Rhode Special Assistant Attorney General Genevieve M. Allaire Johnson.
The matter has been investigated by the Office of Inspector General for the Department of Health and Human Services.