AG sues addiction treatment center chain for alleged Medicaid fraud

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Staff Writer
Published: 10/22/2020 10:15:46 AM
Modified: 10/22/2020 10:15:38 AM

The state Attorney General’s Office is suing a national addiction treatment center chain formerly headquartered in Northampton for allegedly submitting millions of dollars in false claims to the state’s Medicaid program.

The complaint was filed Friday in U.S. District Court in Massachusetts under the Massachusetts False Claims Act against Total Wellness Centers LLC, CleanSlate Centers Inc., and CleanSlate Centers LLC (collectively, “CleanSlate”), and former company owner Dr. Amanda Louise Wilson, according to a statement released by the Attorney General’s Office.

According to CleanSlate Centers’ website, the company provides medication-assisted treatment for people struggling with opioid or alcohol addiction at locations across the country. The attorney general alleges that since April 2011, the chain submitted millions of dollars in false claims to MassHealth for urine drug tests that were medically unnecessary and violated federal and state self-referral laws because the tests were performed at their own laboratory.

“This company’s business model was to illegally profit by cheating our state Medicaid program, which provides vital health care resources to some of our most vulnerable residents,” Attorney General Maura Healey said in a statement. “We will take legal action against this kind of misconduct in order to recover funds for our state and protect the integrity of MassHealth.”

The allegations were originally made in a case filed by a whistleblower in April 2017 under the whistleblower provision of the False Claims Act, which allows private parties to sue on behalf of the government, according to the statement. The case was unsealed in late July this year. The act also allows governments to intervene in those actions, which Massachusetts did by filing the lawsuit.

CleanSlate had its headquarters in Northampton before relocating to Tennessee. It has locations across the state — including on Arch Place in Greenfield and on South Main Street in Athol — and operates an independent clinical laboratory in Holyoke.

In a statement, CleanSlate said it is “disappointed with the attorney general’s decision to intervene in this matter.”

“We strongly believe this claim is without merit, and we look forward to the opportunity to demonstrate in court that the care provided to our patients was outstanding and the lab tests that were ordered were medically necessary,” the statement reads. “Maintaining a culture of integrity is of the utmost importance to our company and we remain confident that our business practices and policies fully comply with both federal and state law. ”

According to the complaint, MassHealth pays for the type of office-based opioid treatment that CleanSlate offers in its centers. The complaint says that patients submit to a low-complexity urine test every time they come to the company’s centers to receive treatment. There are also several other more complex types of urine drug tests, known as “quantitative tests,” that can be ordered for patients.

The Attorney General’s Office alleges that, among other things, the defendants sometimes ordered more than one test during a visit, resulting in duplicate testing; reflexively ordered more quantitative tests if a preliminary urine test came back showing a substance; and do not check the results of the less-complex urine drug test unless a person returns to CleanSlate.

“These situations result in medically unnecessary tests ordered and/or billed by CleanSlate, thereby resulting in submission of false claims,” the complaint reads.

Company policy also dictates that these urine tests, as well as some others, must be performed at the company’s own laboratory, the complaint states. This violates federal and state laws prohibiting the self-referral of laboratory testing, “thereby resulting in submission of false claims,” according to the complaint. According to the attorney general’s statement, Wilson “owned both the clinic and lab in Massachusetts and developed the policies directing the self-referrals.”

The Attorney General’s Office is also accusing the defendants of engaging in practices that led to the backdating of prescriptions by physicians. The office argues that as a result of the medically unnecessary urine drug tests, the self-referrals to a laboratory they owned and the backdating of prescriptions, the defendants submitted, or caused to be submitted, claims for service in violation of MassHealth regulations.

“Defendants knew or should have known of these violations, yet billed MassHealth and MCEs (managed care entities) as if the services had been provided in full compliance with state and federal laws and MassHealth regulations,” the complaint reads.

In 2017, CleanSlate Centers Inc. and Total Wellness Centers LLC agreed to pay $750,000 in a settlement with the U.S. Attorney’s Office for improperly prescribing and billing for Suboxone.

Michael Connors can be reached at mconnors@gazettenet.com.

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