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Date: 02-11-2019

Case Style:

United States of America v. Families United Services and Pamela McKenzie

Case Number:

Judge: Not Available

Court: United States District Court for the Northern District of Georgia (Fulton County)

Plaintiff's Attorney: Lena Amanti and Sara Vann

Defendant's Attorney: Not Available

Description:





Atlanta, GA - Families United Services and Pamela McKenzie to pay $645,000.00 and agree to exclusion in order to resolve False Claims Act allegations

Families United Services, Inc. (FUS) and Pamela McKenzie, the owner of FUS, have agreed to pay $645,000, and to be excluded from federal health care programs for a period of five years to resolve allegations that they submitted claims to the Georgia Medicaid Program for behavioral health services that they never provided. The effect of the exclusion is that federal health care programs will not make any payments to FUS or McKenzie, or anyone who employs them, for any services that they have provided.

“Georgia Medicaid provides valuable mental health services and treatment for many of Georgia’s most vulnerable citizens,” said U.S. Attorney Byung J. “BJay” Pak. “False billing of the Georgia Medicaid Program diverts monies for citizens who depend on Medicaid for vital medical care. Our pursuit of individuals who defraud federal health care programs will not cease.”

“Working with our law enforcement partners, we are dedicated to protecting patients and the federal health care programs intended to serve them,” said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “Using our exclusion authority is a great remedy for banning bad providers from the program and protecting the American taxpayer.”

“We appreciate the Department of Community Health’s Program Integrity Section for being diligent in bringing this issue to our attention to investigate,” said Attorney General Chris Carr. “We will continue to work with our federal partners and root out those organizations and individuals that cross legal boundaries and do so at the expense of taxpayers.”

The government alleges that FUS and McKenzie violated the False Claims Act, 31 U.S.C. § 3729, et seq., by causing the submission of false claims to the Georgia Medicaid Program between October 1, 2010 and June 10, 2012 for behavioral health care services that were never provided.

FUS is a Georgia corporation that was enrolled with the Georgia Department of Community Health to provide behavioral health services. Between October 1, 2010 through June 10, 2012, FUS provided services to Medicaid members under two programs operated by the Georgia Department of Behavioral Health and Developmental Disabilities—Assertive Community Treatment (ACT) and Core. ACT is a recovery focused, high intensity, community based service for adults with severe and persistent mental illness. Core services are a comprehensive range of outpatient and out of center mental health services provided to persons of all ages. The Georgia Medicaid Fraud Control Unit initiated its investigation after receiving a referral from the Program Integrity Section of the Georgia Department of Community Health.

This settlement highlights a powerful tool to protect federal health care programs and beneficiaries and to hold accountable those who commit health care fraud—the exclusion authority of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). Section 1128 of the Social Security Act gives HHS-OIG the authority to exclude individuals and entities from participation in federal health care programs for fraud or other misconduct.

The claims resolved are allegations only, and there has been no determination of liability.

This case was investigated by the U.S. Attorney’s Office for the Northern District of Georgia, the Georgia Medicaid Fraud Control Unit, and the U.S. Department of Health & Human Services Office of Inspector General.

The civil settlement was reached by Assistant U.S. Attorney Lena Amanti and Assistant Attorney General Sara Vann.

For further information please contact the U.S. Attorney’s Public Affairs Office at USAGAN.PressEmails@usdoj.gov or (404) 581-6016. The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.

Outcome: Settled for $645,000.00.

Plaintiff's Experts:

Defendant's Experts:

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