The Ellington Behavioral Health clinic and Dr. Erum Shahab, the psychiatrist who owns the clinic, will pay $805,071 to settle a whistleblower claim that they were overbilling Medicare for urine tests. Connecticut Attorney General George Jepsen announced that the settlement deal had been reached.

A whistleblower complaint was filed in Connecticut against Dr. Shahab and the Ellington Behavioral Health Clinic by realtor Dr. David Simon. Simon was a former employee at Ellington Behavioral Health Clinic who accused the defendants of overbilling Medicare. 

Simon claimed that Shahab improperly submitted claims to Medicare for multiple urine tests for one patient, when only one urine test billing was needed. Allegedly, this action violated the federal and state False Claims Act.

Simon states that Ellington Behavioral Health regularly ran drug tests through the patient clinic, and used urine testing for such tests. He states that in a urine drug screening test, a single sample can be used to test for multiple types of drugs, and for this reason, only one test should be billed per patient encounter.

He claims that Shahab and the clinic submitted multiple drug test claims to Medicare per patient encounter, thus receiving thousands of dollars from Medicare that they would not have received had they properly billed the tests.

For his role in uncovering the alleged wrongdoings, Simon will receive $99,113 of the settlement, in accordance with whistleblower provisions in both the federal and state False Claims Act, which determine that a whistleblower is entitled to a percentage of proceeds garnered in any case ruling or settlement deal.

The government alleges that Shahab and the clinic knowingly abused the Medicare program, and knowingly violated the False Claims Act — the government claims that Shahab and Ellington Behavioral Health knew or should have known of the proper methods of billing.

Additionally, the government claims that in many cases, Shahab and the clinic submitted Medicare claims for urine drug tests when they never actually tested the samples, and in many other cases, tested the samples weeks or months after they were collected from patients. Allegedly, these practices were intentional and systemic, as opposed to the result of negligence. Allegedly, the company and Shahab were unjustly enriched by their acts of defrauding Medicare.

On Ellington Behavioral Health’s attempt at overfilling Medicare to increase clinic profits, U.S. Attorney Durham states that “physicians and their medical practices must carefully code their claims, honestly bill for services, and ensure that taxpayers’ health care dollars are properly spent… The U.S. Attorney’s Office and our federal and state investigative partners will hold to account all heathcare providers who submit false claims to federal health care programs.”

Monday’s settlement deal will cover urine drug test claims submitted to Medicare by the Ellington Behavior Health mental health clinic between Jan. 1, 2011, and Sept. 30, 2013, and between Jan. 1, 2014 and June 30, 2014.

The Ellington Behavior Health Mental Health Clinic Overbilling Medicare Settlement was investigated by the Federal Bureau of Investigation; U.S. Department of Health and Human Services, Office of the Inspector General; the U.S. Postal Service, Office of the Inspector General, and the Defense Criminal Investigation Service. The case is prosecuted by Assistant U.S. Attorney Richard M. Molot and by Assistant Attorney General Gregory O’Connell of the Connecticut Office of the Attorney General.