DOJ Settles FCA Case With Opioid Treatment Provider

The government’s continuing focus on the opioid epidemic and substance use disorder treatment services was underscored this week by a Justice Department settlement with Springbok Health, Inc., and owner/CEO Mark Jankelow to resolve False Claims Act (FCA) allegations involving Medicare and Medicaid billing.

According to the government’s allegations, Springbok billed Medicare and Medicaid for highly reimbursed Evaluation & Management services when in reality the clinics only provided counseling services to its patients, which are reimbursed at a much lower rate. Due to a demonstrated inability to pay the full statutory damages under the FCA, Springbok and Jankelow will collectively pay between $125,000 and $335,494 to settle the government’s claims, depending on resolution of the “ability to pay” process.

While this settlement won’t make headlines based on its dollar value, it demonstrates two lasting lessons for providers, particularly those in fields related to the opioid epidemic and behavioral health.

1. This settlement is yet another example of DOJ’s application of the Yates Memo, a 2015 memo from then-Deputy Attorney General Sally Yates that established DOJ’s policy relating to individual accountability for corporate wrongdoing. By holding not just the clinics liable in this case but also their owner and CEO, the government once again responded to alleged corporate fraud by taking to task the individual executive it considers personally responsible for the company’s conduct.
   
   
2. While allegations of upcoding and billing for services not actually provided are not limited to substance use disorder treatment clinics and providers, DOJ and state Medicaid Fraud Control Units (MFCUs) have demonstrated an increasing interest and focus on any and all services related to the opioid epidemic, even providers who are focused on combatting opioid addiction.

Healthcare providers in fields related in any way to the opioid epidemic should pay heed to this settlement. The government is unrelenting in its focus on the opioid epidemic, and this FCA case will likely not be the last to focus on opioid treatment providers rather than opioid abuse and prescribing practices.