Missouri AG announces $500,000 Medicaid fraud settlement

(The Center Square) – A residential treatment facility for children suffering from sexual behavior disorders and mental health illnesses agreed to a $504,250 civil settlement for fraudulently billing the Missouri Medicaid program in 2019 and 2020.

Piney Ridge Center, located in Waynesville, admitted to filing false claims seeking payment for therapy sessions for 13 children and adolescents. It billed MO HealthNet, Missouri’s Medicaid program, for two sessions a week of at least one hour per session for each child, as required by state regulations.

“In this Medicaid fraud case, my office recovered over $500,000 in restitution and damages, a great result for the Missouri Medicaid system,” Republican Attorney General Eric Schmitt, a candidate for the seat of retiring Republican U.S. Senator Roy Blunt, said in a statement announcing the settlement. “This is the largest Missouri-only civil settlement my office has obtained in recent years, which underscores the importance of our Medicaid Fraud Control Unit in identifying Medicaid fraud and taking legal action to prevent it.”

The Attorney General’s Medicaid Fraud Control Unit (MFCU) discovered the discovered the fraudulent activity. Missouri’s MFCU receives 75% of its funding from the U.S. Department of Health and Human Services from a $2.8 million grant during federal fiscal year 2021. The remaining 25%, approximately $939,601, is funded by the state.

The case was prosecuted by assistant Attorney General Robert J. Estep and investigated by MFCU Investigators Dylan Lorenz and Robert McMahan.

Perimeter Healthcare, based in Alpharetta, Ga., lists Piney Ridge Center as one of its facilities. Information on its website describes Piney Ridge Center as a 96-bed residential treatment center. “All residents receive individualized treatment including: individual, group, family therapy, educational plans, and psychiatric services to change teens from self-defeating to self-enhancing lifestyles,” according to an online brochure.

A phone message left at Perimeter Healthcare wasn’t returned.

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