AG HEALEY SUES NATIONAL ADDICTION TREATMENT CENTER
CHAIN FOR ORDERING MEDICALLY UNNECESSARY DRUG TESTS AND VIOLATING SELF-REFERRAL
LAWS
AG’s Office Intervenes in Whistleblower False Claims
Act Case; Company Allegedly Submitted Millions of Dollars in False Claims to
the State’s Medicaid Program
BOSTON – Attorney General Maura
Healey announced today that her office has sued a national addiction treatment
center chain for submitting millions of dollars in false claims to the state’s
Medicaid program, known as MassHealth, for urine drug tests that were medically
unnecessary and violated federal and state self-referral laws because they were
performed at the company’s own laboratory.
The
AG’s Office filed the complaint
in U.S. District Court in Massachusetts under the
Massachusetts False Claims Act against Total Wellness
Centers, LLC, CleanSlate Centers, Inc., and CleanSlate Centers, LLC
(collectively, “CleanSlate”), and former company owner Dr. Amanda Louise Wilson.
“This
company’s business model was to illegally profit by cheating our state Medicaid
program, which provides vital health care resources to some of our most
vulnerable residents,” said AG Healey. “We will take legal action against this
kind of misconduct in order to recover funds for our state and protect the
integrity of MassHealth.”
CleanSlate
was based in Northampton before it relocated its headquarters to Tennessee. The
company owns and operates many office-based opioid treatment centers in
Massachusetts and around the country, where individuals receive
medication-assisted treatment for substance use disorders. Locations in
Massachusetts include Athol, Boston, Falmouth, West Springfield, and Worcester.
CleanSlate also owns and operates an independent clinical laboratory in Holyoke
where it performs tests of clinical specimens for its patients.
The AG’s
lawsuit alleges that CleanSlate
required patients, depending on their stage of treatment, to submit to a
variety of qualitative and quantitative urine drug tests, some of which were
medically unnecessary. The AG’s Office also alleges that CleanSlate and Dr.
Wilson caused false claims to be submitted to MassHealth and its contracted
managed care entities for these unneeded tests, which violate medical necessity
requirements under MassHealth regulations.
The AG’s complaint also alleges that the company’s
policies, which directed clinicians at CleanSlate to refer laboratory work to
its own Holyoke laboratory, violate federal and state self-referral statutes.
Dr. Wilson owned both the clinic and lab in Massachusetts and developed the
policies directing the self-referrals.
The
self-referral law, originally proposed by the AG’s Office, prohibits referrals
between clinical laboratories and any entity with a direct or indirect
ownership interest in the laboratory and vice versa. State law also prohibits a
laboratory from testing any specimen received from an entity with an ownership
interest in the laboratory.
These allegations were originally made in a case filed in April 2017 under the
whistleblower (or qui tam) provision of the False Claims Act. The act
permits private parties to sue for fraud on behalf of the government, and it
also permits federal and state governments to intervene in such actions, as
Massachusetts has done in this case, which is captioned U.S. et al. ex rel.
Wendy Welch v. CleanSlate Centers, Inc., et al.; Civil Action No.
17-CV-30038-MGM (D. Mass.).
This
matter is being handled by Managing Attorney Kevin Lownds, Assistant Attorney
General Gregoire Ucuz, Senior Healthcare Fraud Investigator Steven Pfister, and
Investigator William Welsh, all of the AG’s Medicaid Fraud Division, with substantial assistance from the U.S. Department
of Health and Human Services, Office of the Inspector General.
The AG’s Medicaid Fraud Division
receives 75 percent of its funding from the U.S. Department of Health and Human
Services under a grant award. The remaining 25 percent is funded by the
Commonwealth of Massachusetts.
