By: Christopher A. Parrella, Esq., CPC, CHC, CPCO
Parrella Health Law, Boston, Ma.
A Health Law Defense and Compliance Firm

July 24, 2024 – Houston, TX

The U.S. Attorney’s Office for the Southern District of Texas announced a significant settlement involving two mental health care providers in the South Texas area. Texas Behavioral Health PLLC (TBH) and United Psychiatry Institute LLC (UPI) have agreed to pay $1,083,000 to resolve allegations under the False Claims Act (FCA) concerning the submission of false claims to Medicare, TRICARE, and Medicaid.

Allegations and Improper Billing
From 2017 to 2020, TBH and UPI allegedly engaged in a pattern of falsely billing Medicare Part B for mental health services. According to the allegations, these providers submitted claims for services rendered by non-physician personnel but billed at the higher physician rate. This occurred despite Medicare regulations requiring that services must be either directly rendered or supervised by a physician.

Some of the services billed occurred on dates when the physicians were outside of the United States, making it impossible for them to have provided or supervised the services. Additionally, the volume of patients across multiple locations further highlighted the impracticality of the claimed physician supervision.

Non-Physician Practitioners and Billing Requirements
Non-physician practitioners can indeed provide mental health services; however, they must bill under their own benefit categories and provider numbers. TBH and UPI failed to adhere to this requirement, resulting in improper reimbursements from Medicare, TRICARE, and Medicaid.

Statements from Officials
“For a system to provide affordable mental health services, it’s important for healthcare providers to give accurate information about who is providing the services – not supply misinformation in an attempt to fleece that system,” stated U.S. Attorney Alamdar S. Hamdani.

Christopher Parrella, ESQ, CPC, CHC, CPCO, is the founding partner of Parrella Health Law in Boston, Mass. The firm focuses exclusively on healthcare defense and compliance matters. Chris also travels the country on behalf of a wide range of healthcare organizations, lecturing on a variety of health care enforcement and compliance topics. Chris is one of a handful of health care attorney’s that are also Certified Professional Coders (CPC) and is a member of the AAPC’s National Legal Advisory Board and Ethics Committee.  He is also a Certified Professional Compliance Officer (CPCO) and Certified in Health Care Compliance (CHC.)