A licensed clinical social worker in Connecticut is facing Medicaid abuse charges in a False Claims Act (FCA) lawsuit filed by Attorney General George Jepsen and State Department of Social Services (DSS) Commissioner Roderick L. Bremby.

The defendant in this Medicaid abuse case is Elijah C., owner and operator of A Prospering Vision LLC.

He is also the Founder and President of Home of Hope Inc., an alleged nonprofit organization serving homeless single mothers. Home of Hope is a supposed housing program that helps this population transition to more stable employment and living situations over the course of a year.

Both companies are located in Waterbury and signed up as behavioral health providers with the Connecticut Medical Assistance Program (CMAP).

Elijah C. is accused of inappropriate billing of CMAP up to several millions of dollars. The alleged Medicaid abuse took many forms. The State of Connecticut believes that the licensed clinical social worker put in claims for reimbursement of services that were either not given or given by unlicensed people.

These unlicensed people were not qualified to be handling the intricacies of providing mental health services to homeless or other specialized populations served by CMAP.

The State also indicates in their Medicaid abuse allegations that Elijah C. chose to use insurance coding when putting in claims for service that reflected more expensive services than were actually given in an effort to secure more funds from the public health program. This is a practice known as “upcoding”

On several occasions, according to the Medicaid abuse case brought forward by the State of Connecticut, Elijah C. billed CMAP for a standard hour of psychotherapeutic services regardless of whether the stated patient did or even could show up for the appointment.

It was allegedly discovered that some of the claims put in for certain patients occurred while they were imprisoned, hospitalized, or out of the given region of services.

In addition to billing for no-shows and otherwise unavailable patients, Elijah C. supposedly also billed for psychotherapy services in instances where medication management was the only real service provided.

This service is paid at a lower rate by CMAP, so the actual service was purportedly ignored in favor of a psychotherapeutic hour when putting in a claim—a better paid service that could yield thousands of dollars over time.

A warrant for Elijah C.’s arrest has been issued by the Office of the Chief State’s Attorney’s Medicaid Fraud Control Unit (MFCU). The charges that are part of the arrest warrant include larceny and prescription drug fraud. These charges remain just allegations until proven to be true beyond a reasonable doubt in a court of law.

The action was coordinated between MFCU and DSS’s Office of Quality Assurance Special Investigations Unit. The time period in question for the accusations is a three and a half year period between March 2013 and December 2016.