A Southern California center for autistic children has paid $650,000 to resolve allegations that it billed the state’s Medicaid Program (Medi-Cal) for services without providing care to children.
Prism Behavioral Solutions provides treatment to children diagnosed with autism and other related disorders through a therapy called Applied Behavioral Analysis throughout Southern California.
The United States and the State of California alleged that Prism Behavioral Solutions violated the federal False Claims Act and the California False Claims Act by knowingly submitting false claims to Medi-Cal for medical services that Prism Behavioral Solutions did not perform from September 2016 through December 2019.
According to a whistleblower’s complaint filed in San Diego federal court in 2019, this included the company billing Medi-Cal for canceled appointments. Prism owes $650,000 to the state and federal governments.
California expects to receive $390,000 of the settlement based on the company’s ability to pay, according to the U.S Attorney’s office.
“Prism had the important responsibility of supporting and caring for children and young adults with autism spectrum disorders,” said Attorney General Rob Bonta. “Instead of fulfilling its obligation to the families under its care, Prism is alleged to have filed false claims and misused state taxpayer money. These allegations are shameful and these families deserved respect and dignity, not to be used to cheat state resources.”
The whistleblower received $130,000 as a part of the settlement.
“Billing government health care programs for services not rendered negatively impacts the entire health care system,” said U.S. Attorney Randy S. Grossman. “This settlement shows our continuing commitment to protect the integrity of government health care programs and other taxpayer-funded programs.”
