PROVIDENCE — Fatal drug overdoses are staggeringly high in Rhode Island right now, and the demand for drug-addiction treatment has risen along with the death toll.
Some providers in the state have used this tragedy as an opportunity to enrich themselves, without regard for the law, authorities allege.
In two recent court cases, one of them civil and one of them criminal, authorities have accused private Rhode Island companies of improperly billing government healthcare programs. The unrelated companies worked in different areas of substance use treatment, and authorities are bringing the legal actions against them under different areas of the law.
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But the cases largely center around fundamentally similar allegations: wrongfully billing for services and shortchanging patients.
“If we can get in there and both correct the conduct and bring some accountability for this, that sets down a marker to folks who look at this particular area of health care and say, ‘Hey, it’s easy pickings for us to come in, open up a center and help ourselves to federal dollars’,” U.S. Attorney Zachary Cunha said in an interview Wednesday at his office. “What we hope to do by moving quickly and bringing cases like this is to send the message that no, if you do that, there are going to be consequences.”
Cunha’s office brought the criminal case, announced in March, and joined the civil case in April. Before becoming the top federal prosecutor in Rhode Island for the Department of Justice, Cunha had worked on a number of health care fraud cases.
“It’s the regrettable reality that wherever the money is, and wherever the opportunity is, someone is going to try to commit fraud and take advantage of that,” Cunha said. “And the faster you can get in there and take action to hold them accountable for that, the better off we’re going to be.”
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In March, Cunha’s office announced criminal charges against Providence-based Recovery Connection Centers of America and two people involved in the office-based opioid treatment program chain, which had locations in Massachusetts and Rhode Island. RCCA is not to be confused with the Massachusetts-based company with a similar name.
The owner and operator Michael Brier, also charged in the case, had pleaded guilty to tax evasion in 2013 — but that fact was concealed in the company’s application to participate in the Medicare program, prosecutors said. As investigators tell it, things at Recovery Connection didn’t get much better from that inauspicious start: falsified records, billing for 45-minute counseling sessions that actually lasted two minutes, and Brier telling one witness who’d talked to the feds: “You should have kept your mouth shut.”
Brier, who was not a doctor, is also accused of writing prescriptions of Suboxone, a medication used to treat opioid use disorder. All told, prosecutors said the defendants enriched themselves with millions in federal and private healthcare money they didn’t earn.
Attorneys for RCCA and Brier didn’t respond to requests for comment. A federal judge appointed a court-ordered receiver for RCCA, and patients had to scramble to find continued care. The chain had about 1,600 to 1,800 patients across Rhode Island and Massachusetts.
In a separate case, unveiled late last month, Cunha’s office and the office of Rhode Island Attorney General Peter Neronha joined a civil lawsuit against The Journey to Hope, Health, and Healing, Inc., which was a drug and alcohol treatment provider with four locations in Rhode Island.
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Unlike RCCA, this one could administer methadone, an effective but tightly regulated medication used to reduce cravings and withdrawal from other opioids. The government alleged in its civil suit that the Journey billed Medicaid for bundled medication-assisted treatment services even though it wasn’t providing things like updated individual treatment plans or adequate rehabilitative counseling for patients. Those other services were required, the authorities said in their suit.
Facing an audit, its management directed employees to create and backdate documents to make it seem like these treatment plans were actually being completed and updated and that the counseling was happening, authorities said.
From January 2015 to July 2021, the Journey got more than $15 million in Medicaid payments for bundled methadone treatment services. More than half were for patients “who were not receiving required services,” the state and federal governments said.
The civil lawsuit was originally filed under seal in October 2020 by two whistleblowers who worked for the Journey (which has since been sold and operates under new ownership and a new name).
The former CEO of the Journey denied the claims in the lawsuit, in which he’s also a defendant.
“We strongly disagree with these allegations and intend to vigorously contest them,” Kenneth L. Richardson Jr. said in an email, adding that “every dose of methadone billed was clinically appropriate and provided as prescribed.”
Joel Goloskie, attorney for the Journey, said the government shouldn’t have brought a False Claims Act case over what amounts to “record-keeping lapses and other regulatory shortfalls.”
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The civil litigation was filed under the False Claims Act, which allows whistleblowers to sue on behalf of the government over fraudulent billing; the government itself can join the lawsuits, which happened in this case. If successful, the whistleblowers would share in the recovery.
“Moreover, the state was well aware of the Journey’s regulatory issues, yet kept paying as they worked with the Journey to resolve compliance issues that plague the entire industry, and arise largely from an ongoing workforce shortage,” Goloskie said in a written statement, which is available in full online. “The Journey delivered life-saving methadone, and never billed for any week in which such methadone was not delivered.”
(In an interview, Cunha, the top federal prosecutor, pushed back on the notion that cases like these — he wasn’t commenting on a specific one, but in general — are about record-keeping lapses.)
The people who brought the original lawsuit were Sara Quaresma and Michael DelMonico, who worked at the Journey. Their initial suit included allegations that Quaresma was intimidated, ridiculed, and threatened with firing after she raised alarms about what she considered unlawful billing practices with the state. One person at the company, whose name was redacted in court filings, reportedly warned attendees at a meeting, including Quaresma, against “airing the Journey’s dirty laundry.”
There were hampersful to go around, in the government’s telling: Some Medicaid patients kept testing positive for illegal drugs, which didn’t prompt increased services or attention, the suit says. A counselor reported that patients were being exploited, with a culture of tricking people into thinking services were being provided that weren’t. One former supervisor there testified under oath that she worried people would die as a result of the Journey’s conduct. And one employee there entered 40 nearly-identical counseling notes in a week indicating an hour of counseling had been provided even though it hadn’t.
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When one former employee raised concerns with Richardson about the Journey’s practices, “Richardson instructed the employee not to report this information to state authorities,” the government’s suit said.
“I think there’s a desperate need for” drug addiction treatment, Louise Herman, the attorney for the two whistleblowers in the civil case, said in an interview. “And I think that the system is broken. There’s a real problem. Other than greed, I really don’t know where it originates.”
Herman said she’s glad the government is stepping in to help.
“We’re looking forward to litigating this case with them,” Herman said, “to hopefully address this horrific kind of practice.”
These cases, according to legitimate providers of substance use disorder treatment, have cast a harsh light on a medical field that already deals with stigma, even though the allegedly fraudulent ones are still very much in the minority.
“To me, it’s appalling,” said Linda Hurley, CEO of the nonprofit opioid treatment provider CODAC Behavioral Healthcare who is also the chair of the Opioid Treatment Association of Rhode Island. “It’s really appalling. People are making millions and millions and millions of dollars.”
Hurley said the field does have guardrails — even, in some cases, guardrails that might not always be entirely necessary, like requiring annual physicals or regularly updated treatment plans that patients don’t want or may not actually benefit from. But the solution to rules that are in need of change is to advocate for changing them, not to break them, Hurley said. And these two cases — in which authorities allege not just corner-cutting but more fundamental wrongdoing — won’t help the stigma problem, Hurley said.
“I’m angry and frustrated,” Hurley said. “It makes all our jobs so much harder.”
The cases have provoked more than just consternation. The state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals said in an email that based on these incidents, it’s investigating licensing options, “with the goal of assuring that clients receive the highest-quality services.”
“BHDDH is always concerned when individuals who are authorized to provide care abuse the trust of their patients, families, and the public,” spokesman Randal Edgar said.
BHDDH licenses behavioral health treatment facilities, and the Journey did have to be licensed by BHDDH. But it isn’t uncommon for groups of independently licensed clinicians to band together to form a business entity. In cases like these it’s not licensed by BHDDH, Edgar said. Recovery Connection was one such case that fell into this regulatory gray zone, Edgar said.
“This is one of the areas BHDDH is looking at, to see if other licensing options would better assure delivery of the highest-quality services,” Edgar said.
Brian Amaral can be reached at brian.amaral@globe.com. Follow him on Twitter @bamaral44.