The Centers for Disease Control and Prevention says that 1 out of 59 American children are autistic. Hundreds of thousands school age children have autism, a range of conditions characterized by challenges with social skills, interpersonal relationships, repetitive behaviors, speech and nonverbal communication. Medical professionals characterize it as a developmental disability, although many people diagnosed with the disorder are very highly functioning.
As society focuses more on autism, new and competing therapies emerge. One of those oldest therapies is Applied Behavioral Analysis (ABA). Treatment opportunities are rapidly expanding as many states have now required Medicaid and private health insurance to pay for ABA and other autism therapies.
One of the largest provider of autism care today is Centria. As of February, the company boasted 5000 employees providing services in 9 states. (Arizona, California, Michigan, New Jersey, New Mexico, Ohio, Oregon, Texas and Washington.)
Earlier this year a group of whistleblowers claimed that Centria was defrauding Medicare. Despite tough anti-retaliation laws, the company sued the employees for defamation. The battle lines were quickly drawn. Centria claims that it runs a clean operation. The three former employees paint a much different picture.
The whistleblowers claim the company is guilty of a wide range of fraud including forgery, HIPAA (patient privacy) violations, billing fraud, falsifying healthcare records and employing unqualified people. As whistleblower lawyers, we see the theme of their claims repeated in many cases – profits before patients.
Usually whistleblower claims would be sorted out years down the road in court. The company is seeing red, however, and wants not only the fraud claims dismissed, it also wants to three whistleblowers to be punished.
Retaliation against whistleblowers can be quite effective, although its illegal. By filing a lawsuit against the whistleblowers, corrupt companies hope to send a stern warning to would-be whistleblowers. “If you blow the whistle, we will punish you.” That sort of bully behavior typically has a chilling effect on other workers.
The lawsuits come on the heels of an $8 million state grant awarded in 2017 to Centria. The monies are to be used to extend autism services and Applied Behavioral Analysis to an underserved group of patients, many in the poor and minority communities.
The company plans to add 1200 news jobs in Michigan, many of them ABA therapists.
Applied Behavioral Analysis – Treatment or Scam?
Many of the “therapists” working for Centria are classified as “behavior technicians.” Despite the fancy title, these technicians do not need a college education and only make $13 or $14 per hour to start.
Lack of proper training for the techs doesn’t mean the company is a scam. It certainly raises red flags for us, however.
According to Centria’s lawsuit against its former employees, the three whistleblowers defamed the company by releasing a so-called “law enforcement summary.” In that summary, the trio claim that the Centria and some of its executives engaged in serious wrongdoing including:
- Engaged in a racketeering scheme specifically designed to falsely diagnose kids with autism who either do not have autism or have milder symptoms of the disorder. By misdiagnosing kids as autistic, the company could bill Medicaid or private insurance upwards of $50,000 per year per child.
- Forged parent signatures on patient care contracts. They claim this was especially prevalent with parents who did not speak English.
- Defrauded Medicaid.
- Violated HIPAA and patient confidentiality rules by not properly securing patient files.
The company, of course, vehemently denies the allegations.
Despite the company’s denials, the Detroit Free Press says that it has confirmation that the Michigan Attorney General’s Office is investigating Centria.
Among the more serious allegations are the claims that the company misdiagnosed kids as having autism and engaged in billing fraud. The latter involves claims that the company pushed parents to enroll kids in up to 40 hours a week of therapy even if the kids didn’t need such intense care.
We often see cases where dishonest healthcare companies are more motivated by profit than patient wellness.
In another instance of billing fraud, the Detroit Free Press claims that some Centria employees say they were to pushed to bill for services that were never even rendered. In 2017 the company was cited for billing for home therapy for a patient that was actually in the hospital at the time.
The whistleblower claims against Centria mostly center on billing and medical necessity determinations, but what about the therapy they are providing? Is Applied Behavioral Analysis even effective? (Because it requires so many hours, it is certainly one of the most expensive treatment options.)
ABA is the leading therapy for kids diagnosed with autism. And companies like Centria are happy to provide therapists and bill Medicaid and Medicare for up to 40 hours per week at $55 per hour.
But is it effective? ABA certainly has it advocates. But there are fierce critics who say it is cruel and based on the premise that autistic kids need to be “fixed” and made to be more “normal.” A growing body of behavioral science says that we should accept neurodiversity and recognize that kids with autism are different. We can help them function and communicate but they don’t need 40 hours a week of a forced regimen in an effort to make them “more normal.
One women interviewed said that her son is the product of ABA. After hundreds of hours of Applied Behavioral Analysis, her son can now approach people on the street and say, “Hello, what’s your name.” She worries, however, that her son is becoming a robot. She says he will frequently walk away without waiting for an answer. She doesn’t think he even knows why he is asking people on the street for their name. instead “he just knows to do his part.”
Whistleblower Awards for Autism Scams
We are not medical doctors or behavioral therapists. The debate over Applied Behavioral Analysis is likely to rage on for years. We do know, however, that our children deserve the best care possible. And nothing good can ever come from companies that put profits before kids, that misdiagnose or that bill for unnecessary services or services never rendered.
Is Centria guilty? We will leave that up to the Michigan Attorney General’s Office and the three brave whistleblowers who stepped forward with their claims.
Because ABA is so expensive, we suspect there are real fraudsters in the autism therapy space. Companies that use unqualified therapists (licensing requirement vary widely between states). Companies that bill for more services than were actually provided. And companies that bill for services never even performed.
The fraud fighters at MahanyLaw are ready to help stop the greed and corruption. We also work hard to get our clients the highest whistleblower awards allowed by law.
Whistleblower Awards for Information about Autism Therapy Billing Fraud
29 states and the District of Columbia have Medicaid fraud whistleblower laws that give whistleblowers up to 30% of whatever the government recovers from wrongdoers. Multimillion dollar awards are common.
In addition to the state Medicaid programs, California and Illinois have private insurance whistleblower award programs.
Finally, the U.S. Department of Justice can issue awards in all 50 states and Puerto Rico for information about Medicare fraud and the federal match on Medicaid.
All of these laws require filing a sealed lawsuit in court. That scares away some folks but it shouldn’t. We can handle everything from the investigation to filing of the complaint to meeting with investigators and even trying the case if it comes to that.
The bottom line? Congress and more than half the states have passed powerful laws to encourage whistleblowers to step forward and address fraud and greed. In cases like misdiagnoses, there is another reason to step up. Patient safety.
Being diagnosed with autism can have a lifelong stigma. And it is expensive. When kids are young, an incorrect diagnosis can stick with them and actually impair their development. And for what reason? So a company can pocket an extra few bucks?
This story wouldn’t be complete without addressing retaliation. We have only seen one client ever sued by a wrongdoer. In our experience courts do a remarkable job of protecting whistleblowers. They know companies want to silence anyone who rocks the boat and make an example of them so others don’t follow in their footsteps.
The federal False Claims Act and most states have powerful anti-retaliation laws. We can’t prevent the occasional employer who files a frivolous lawsuit, but we can and will prosecute them for damages. Under federal law, those damages include double damages and attorney fees.
If we take your case we can help you avoid being sued and protect you if you do suffer retaliation.
All inquiries are protected by the attorney – client privilege and kept confidential. There is no fee for a consultation and our services are available on a contingent fee basis meaning you never owe us anything unless we collect money for you.
MahanyLaw – America’s Healthcare Whistleblower Lawyers