Autism provider agrees to $2M settlement

IL file photo

The United States Attorney’s Office for the Southern District of Indiana has recovered $2 million as part of a civil settlement with an Indiana autism therapy provider and its owner over allegations of Medicaid fraud.

The U.S. Department of Justice investigated Indianapolis-based Applied Behavior Center for Autism and its owner and CEO, Sherry Michael, for allegedly submitting false claims to Indiana Medicaid programs, and TRICARE, a health insurance system for members of the military.

ABCA provides autism services throughout Indiana and operates 12 centers. U.S. Attorney Zach Myers’ office said ABCA denies all liability in the case.

The government accused the company of submitting false claims to the government through several fraudulent billing schemes. According to the complaint, the schemes included submitting upcoded, concurrent and duplicate claims, claims for services not covered by TRICARE, and claims already paid by third-party sources.

The DOJ said the estimated loss to the Medicaid program was approximately $348,000 and the estimated loss to TRICARE was more than $625,000. ABCA has agreed to pay $2 million to resolve the government’s allegations, which includes double damages and some of the government’s investigative costs.

“Waste, fraud, and abuse in healthcare claims wrongfully take funds intended to provide needed care to our military and Medicaid families,” Myers said in a statement. “Behavioral services providers must not exploit the needs of patients and families living with autism spectrum disorder to claim public funds to which they are not entitled.”

The U.S. Attorney’s Office said investigators did not uncover any evidence of injury or harm to patients as a result of the alleged conduct.

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