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.