Denver, Colorado — In a recent development, Mile High Psychiatry LLC, a prominent Colorado-based psychiatric practice, and its owner, Michael K. Chism, II, have agreed to a significant settlement of $1.9 million. This resolution comes in response to allegations of fraudulent billing practices that violated the False Claims Act. The case revolves around their alleged double-billing of time, aimed at unlawfully securing higher payments from Medicare and Medicaid.

A Milestone Settlement

Mile High Psychiatry, headquartered in Aurora, Colorado, is renowned for providing telepsychiatry services across the state. However, from 2017 to 2021, the practice and its owner, Michael K. Chism, II, faced accusations of submitting inflated bills to Medicare and Medicaid. These bills sought payment for both evaluation and management services and psychotherapy services, even when provided during the same patient visit. Federal regulations for Medicare and Medicaid emphasize the necessity of separately identifiable services. Specifically, time spent providing one service should not be double-counted when billing for the other. The United States government alleged that Mile High Psychiatry and Mr. Chism knowingly ignored this crucial regulation, leading to the improper double-counting of time, which subsequently led to inflated reimbursements for thousands of patient visits.

Whistleblower Action

The allegations came to light through a whistleblower who utilized the False Claims Act. This act includes qui tam provisions, allowing private individuals to initiate legal actions on behalf of the United States. In return, they are entitled to a portion of the recovery. In this case, the whistleblower will receive approximately $325,000 as her share of the settlement.

A Strong Message

U.S. Attorney Cole Finegan emphasized the government’s commitment to pursuing healthcare providers engaged in unlawful billing practices. He stated, “We will forcefully go after providers who unlawfully bill Medicare and Medicaid. These programs provide vital services for our community, and we will not allow providers to abuse the system or waste taxpayer dollars.” He also underscored the significance of whistleblowers in identifying and stopping fraud, acknowledging that the law permits generous rewards to those who come forward with valuable information.

Special Agent in Charge Curt L. Muller of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) echoed these sentiments. He stressed the importance of healthcare providers adhering to federal healthcare program regulations to maintain the integrity of these safety net programs. Muller also confirmed that HHS-OIG would continue its rigorous efforts to investigate and address allegations of inappropriate billing.

No Admission of Liability

It’s crucial to note that the settlement does not constitute an admission of liability on the part of Mile High Psychiatry or Michael K. Chism, II. This resolution signifies the end of a legal process that allows the parties involved to avoid a protracted legal battle while also serving as a reminder of the consequences associated with fraudulent billing practices in the healthcare industry.