PHILADELPHIA – United States Attorney William M. McSwain announced that Progressions Behavioral Health Services, Inc. (“Progressions”) and Sharmon James, a mental health therapist formerly employed by Progressions, have agreed to pay $27,500 to resolve claims under the False Claims Act set forth in a qui tam complaint filed against them in the United States District Court for the Eastern District of Pennsylvania.

The Complaint alleges that James fabricated mental health treatment records for over 59 outpatient sessions with a minor during the period of May 3, 2017 through October 19, 2018. None of these sessions ever occurred. James allegedly falsified records, forged the signature of the minor’s parent on patient encounter forms, and caused Progressions to submit claims for payment to Medicaid based upon these false records. Pursuant to the agreement, Progressions will pay $17,500 and James will pay $10,000 to the United States.

The settlement resolves allegations in a whistleblower complaint filed in federal court in the Eastern District of Pennsylvania under the qui tam provisions of the False Claims Act. These provisions allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The whistleblower in this matter was the minor’s parent, who will receive approximately $6,700 of the recovery.

“Behavioral health service entities must have strong mechanisms in place – including appropriate supervision and oversight – to avoid fraud and abuse, or else they will face the consequences,” said U.S. Attorney McSwain. “We thank the whistleblower for bringing this qui tam complaint, as well as our law enforcement partners for helping us to pursue this important civil action.”

“Civil enforcement is an important tool in our ongoing battle against health care fraud,” said Maureen R. Dixon, Special Agent in Charge of the Office of the Inspector General for the U.S. Department of Health and Human Services. “We will continue to work closely with the United States Attorney’s Office to ensure the integrity of taxpayer funds and protect beneficiaries of federal healthcare programs.”

The government’s resolution of this matter illustrates the government’s emphasis on combating health care fraud.  One of the most powerful tools in this effort is the False Claims Act.  Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).

This matter was investigated by the U.S. Department of Health and Human Services’ Office of Inspector General and the U.S. Attorney’s Office for the Eastern District of Pennsylvania. The case is assigned to Assistant U.S. Attorneys Viveca D. Parker and Judith A. Amorosa of the Civil Division, and health care fraud auditor Dawn Wiggins.

The qui tam is captioned U.S. ex. rel. Smith v. Progressions Behavioral Health Services, Inc., No. 18-cv-4814 (E.D. Pa.).  The claims resolved by this settlement are allegations only and there has been no determination of liability.