Crossroads — Substance Use Disorder Clinics
Substance Use Disorder Clinics Resolve Medicaid Overbilling Allegations
Source: U.S. Department of Justice
TL;DR: Substance Use Disorder Clinics Resolve Medicaid Overbilling Allegations This case resulted in a Settlement resolution and demonstrates the impact of whistleblower protections in recovering funds from fraud.
Summary
Certain Crossroads-affiliated substance use disorder treatment clinics agreed to pay to resolve allegations that they overbilled Virginia Medicaid for office visits. DOJ and Virginia alleged the clinics billed code 99215 (a high-complexity visit code) for routine check-ins that did not meet the code's requirements, over the period from 2016 through mid-2023. DOJ reported the matter was initiated through a False Claims Act whistleblower case.
Our Take
SUD and behavioral health billing cases often come down to a simple mismatch: what actually happened in the encounter versus what the code requires. Insiders frequently have high-leverage proof—templates used for notes, scheduling patterns that make long/high-complexity visits implausible, and guidance from billing leaders about which codes to "default" to. The most compelling picture is repeatability: the same high code appearing across clinics, providers, and days, regardless of documented complexity.
Read the full article from the original source:
View Original ArticleOpens in a new tab. Content from U.S. Department of Justice.
Notice
The summaries above are based on publicly available information released by the U.S. Department of Justice and are provided for informational purposes only. They do not constitute legal advice, investigative findings, or allegations by Disclosure Strategy. Our commentary reflects general, experience-based observations about how False Claims Act matters commonly arise and is not a statement about any party's liability.