Missouri Attorney General obtains $500,000 settlement in Medicaid fraud case

Medicaid Fraud
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Missouri Attorney General Eric Schmitt announced today that on December 21, 2021, Piney Ridge Center, a residential treatment facility for children suffering from sexual behavior disorders and mental health illnesses, entered into a civil settlement agreement with his office for billing MO HealthNet, the Missouri Medicaid program, for therapy services that it did not provide to children and adolescents. The agreement resulted in a $504,250.46 settlement.

“In this Medicaid fraud case, my Office recovered over $500,000 in restitution and damages, a great result for the Missouri Medicaid system,” said Attorney General Schmitt. “This is the largest Missouri-only civil settlement my Office has obtained in recent years, which underscores the importance of our Medicaid Fraud Control Unit in identifying Medicaid fraud and taking legal action to prevent it.”

The Attorney General’s Medicaid Fraud Control Unit (MFCU) discovered Piney Ridge overbilled MO HealthNet for services that were to be provided to thirteen patients.

In the settlement agreement, Piney Ridge, located in Waynesville, Missouri, admitted that between September 2019 and August 2020, they submitted false claims to MO HealthNet seeking payment for therapy sessions to thirteen Missouri children. The treatment center falsely represented to MO HealthNet that it had provided the necessary therapy to each child, two sessions a week of at least one hour per session, as required by state regulations.

This case was prosecuted by Assistant Attorney General Robert J. Estep and investigated by MFCU Investigators Dylan Lorenz and Robert McMahan.

The Missouri MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $2,818,808 for the federal fiscal year 2021. The remaining 25 percent, totaling $939,601 is funded by the State of Missouri.

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