May 12, 2022. The United States Department of Justice settled a case against a California-based behavioral health provider. Under the terms of the settlement, Prism Behavioral Solutions paid $650,000 to resolve allegations of submitting false claims to state and federal healthcare programs. The whistleblower, a former employee, filed suit under the qui tam provisions of the federal False Claims Act and will receive $130,000 of the government’s recovery.

Prism Behavioral Solutions provides therapy services for children diagnosed with autism. According to the allegations, the behavioral solutions provider billed Medi-Cal for services that were never rendered, including for cancelled appointments, over a period of three years.

California has a state False Claims Act, which functions similarly to the federal False Claims Act, allowing whistleblowers to sue on behalf of the government and receive part of the recovery. Knowingly presenting a fraudulent request for payment to a California government program constitutes false claims under the California FCA.  Medi-Cal is California’s Medicaid program, offering low- and no-cost health insurance to eligible Californians. Medi-Cal is funded by a combination of state and federal taxes.

Submitting false claims to government health programs wrongfully enriches providers for services they did not render and diverts resources from needy patients. Behavioral health workers who have knowledge of situations in which government healthcare programs are being billed for services that did not occur should step forward and report fraud. Qui tam or whistleblower lawsuits are filed “under seal” to give the government time to investigate without tipping off alleged fraudsters.