ST. MARYS — A St. Marys mental health provider is being accused of filing false Medicaid, Medicare and Tricare claims.
According to a civil lawsuit filed in U.S. District Court, former employees with Lighthorse Healthcare say false claims for reimbursement were submitted for work performed by therapists beginning in 2011.
The alleged false claims are said to have been submitted for treatment under medical supervision by a physician to secure a higher reimbursement than would ordinarily be paid. The company had three sites for therapeutic services but only employed one medical supervisor, according to the lawsuit.
The doctor worked one day a week at the St. Marys clinic, no more than two days a week at the Brunswick office, and the doctor was never present at the equine therapy location, according to the complaint.
One employee, Deborah Middleton, was terminated when she raised concerns about the company’s billing practices, the complaint alleges. Another employee, Christi Gallagher claimed her hours and pay were decreased when she expressed concerns about billing practices.
By billing under the doctor’s supervision, the complaint claims the government was defrauded.
The complaint claims the company and director Carlene Taylor violated the False Claims Act and retaliatory discharge under the False Claims Act.
The former employees are asking for reinstatement with the same seniority and pay, two times back pay, prejudgment interest on back pay, compensatory damages, litigation costs and reasonable attorney fees and any other relief the court deems proper.
The former workers are also eligible for a percentage of the money reimbursed for overcharging insurance providers if a jury rules in their favor.
Mario Pacella, the lawyer representing the former employees, said no criminal charges have been filed by the federal government but the state of Georgia will likely pursue a complaint.
The state filed a notice of election to intervene in the federal case under the Georgia False Medicaid Claims Act in March. The filing said the state intends to file its own complaint within 90 days.
“It could result in criminal charges,” Pacella said. “They can probably plead ignorance but it can’t get them out of the civil component.”