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Manchester business pays over $730,000 in settlement following Medicaid faud allegations

Following a whistleblower complaint, the attorney general's office began investigating Manchseter Pediatric Associates, LLC for fraudulent Meidcaid billing.
Credit: Tomasz Zajda - stock.adobe.com

MANCHESTER, Conn. — A pediatric medical practice is paying nearly $740,000 in a settlement following Medicaid fraud charges, according to Attorney General William Tong.

Tong's office made the announcement Thursday morning, saying the settlement with Manchester Pediatric Associates, LLC (MPA) and its owner Dr. Swathanthra Melekote was to resolve the allegations that MPA submitted false and fraudulent Medicaid claims from 2015 to 2021.

“Over the course of more than five years, Manchester Pediatric Associates and its owner Dr. Melekote, knowingly and systematically submitted hundreds of thousands of dollars of false claims to the Medicaid program for services he did not perform to maximize his own profit. These false claims and fraudulent double billing practices misused Connecticut Medicaid resources intended for the medical care of our state’s most vulnerable residents,” Attorney General Tong said. “The Office of the Attorney General takes seriously our responsibility to safeguard our public healthcare programs and is prepared to take strong action against anyone who violates that public trust.”

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Manchester Pediatric Associates serves approximately 5,700 pediatric Medicaid patients in South Windsor, Torrington, and Tolland, according to Tong.

Following a whistleblower complaint, the Office of the Attorney General worked with the Department of Social Services Special Investigations Unit to conduct an investigation into Melekote’s billing practices.

“These inexcusable violations under the False Claims Act have resulted in a major settlement amount being returned the Medicaid program,” Department of Social Services Commissioner Deidre S. Gifford said.  “While such violations do not represent Medicaid providers as a whole, the case underscores the continuing need for strong enforcement of public integrity standards.  I thank the Attorney General and his staff, our DSS anti-fraud investigators, and all partners who work to safeguard taxpayer investments in our health coverage programs.”

The investigation found that Melekote violated the CT False Claims Act by knowingly billing Medicaid twice for maternal depression screenings and vaccine administration and by “up-coding” to bill for medical services as if a physician had provided the services, instead of a physician assistant or nurse practitioner, which would have been reimbursed at a lower rate, Tong said.

Melekote also billed Medicaid for maternal depression screens after a patient was one year old, and without adequate documentation that the service was provided in the patient’s medical records.

According to Tong, the investigation also found that Melekote directed staff to attach numerical “modifiers” to the codes entered on the electronic claim for payment for a service that MPA submitted to DSS’s claims processor. 

This was how MPA was able to reportedly “double bill” for a single maternal depression screen or single vaccine administration, according to Tong.  

MPA employees were told to bill from a “billing guide” created by Melekote without regard to whether the billed services were in the patient’s medical record and without regard to whether a mid-level practitioner rather than a physician providing the service. 

The total settlement amount is $739,759.52 and will be paid no later than Dec. 30.

Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Antitrust and Government Program Fraud Department at 860-808-5040 or by email at ag.fraud@ct.gov; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud, or by email to providerfraud.dss@ct.gov.

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