$15,379,091 Judgment Entered Against Delaware DOC’s Former Health Care Provider for Narcotics and Medicare Fraud
by Chuck Sharman
Under a pair of consent judgments filed in federal court on October 29 and November 1, 2021, troubled former Delaware Department of Corrections (DOC) health care contractor Connections Community Support Programs (CCSP) agreed to pay the federal and state governments a total of $15,379,091.60 to settle claims it committed narcotics fraud and Medicare fraud.
The last judgment entered, for $1,621,571, settled the smaller of two suits filed by the federal government on April 9, 2021, in U.S. District Court for the District of Delaware, accusing CCSP of numerous controlled substance violations, which were first uncovered by Drug Enforcement Administration (DEA) investigators during a 2019 inspection at the nonprofit’s clinic in Millsboro.
That inspection found that CCSP could not account for the whereabouts of 2.4 million milligrams—over 5.2 pounds—of methadone that had been delivered to just that one CCSP location. According to the government’s complaint, that finding triggered “a comprehensive review of controlled substance compliance” by the DEA at all CCSP locations in the state.
The results of that expanded investigation were not good for CCSP, whose compliance with the federal Controlled Substances Act was deemed “haphazard and reactive at best,” the complaint continued. Moreover, the entire investigation took place against a “backdrop of prior violations” dating back to 2013, when CCSP’s contract to provide mental health services to the Delaware DOC was just a year old. See: United States v. Connections Community Support Programs, Inc., et al, USDC, Dist. DE,Case No. 1:21-cv-00514-MN.
The DOC upgraded its contract with CCSP to provide all of its health care services beginning in 2014 and ended the contract in 2020. By that time, former employees Douglas and Malika Spruill had filed a “whistleblower” suit, accusing CCSP of Medicare and Medicaid fraud.
Both the federal government and the state of Delaware intervened in that suit in 2021, accusing the firm of numerous violations of the False Claims Act committed between 2015 and 2019, when the Spruill’s suit was filed.
Specifically, the complaint said that CCSP had defrauded Medicare and Medicaid by “billing for mental health services that were performed by individuals whose professional qualifications did not allow them to bill Medicare or Medicaid for reimbursement.” CCSP was also accused of bilking Medicaid out of higher payments than it deserved by falsifying procedure codes for providers performing mental health services.
The firm entered into a consent judgment in that suit on October 29, 2021, agreeing to pay $13,757,520.60 in settlement of the claims—$8,137,105.54 to the federal government and the balance of $5,620,415.06 to Delaware. United States ex rel. Spruill et al. v. Connections Community Support Programs, Inc., USDC, Dist. DE,Case No. 1:19-cv-00475-CFC.
CCSP also filed for bankruptcy, shortly after the government filed its suits in April 2021, listing debts of $30 million owed to 30 creditors. Then, after reaching its settlement with the government in August 2021, the company filed on September 2, 2021, to change its bankruptcy case from a Chapter 11 reorganization to a Chapter 7 liquidation.
Another “whistleblower” suit filed in 2019 against CCSP by one of its former employees, Tracey Crews, accused the firm of negligent care of 49-year-old Luis Cabrera, a prisoner who “died in agony” of an untreated ulcer in 2018 at the Howard R. Young Correctional Center, where Crews worked. His family also sued CCSP for his wrongful death.
A report published by the Delaware News Journal on October 14, 2021, detailed the news organization’s frustration in attempting to ferret out the state’s role in CCSP’s failures, with Freedom of Information Act requests largely denied by officials with the state Department of Health and Social Services who pointed to language in the state’s contract with CCSP that cloaked the agency’s related investigative files in secrecy.
A member of the Delaware Coalition for Open Government, John Flaherty, told the paper that “the state is obstructing what should be the legal dissemination of public documents here by making up this mythical investigatory files.”
As was deduced by a patient care ombudsman appointed during its bankruptcy proceeding, the company apparently “relied on the state to provide feedback as to whether the debtor was in compliance.”
In other words, CCSP was not proactively policing its own performance but instead was counting on the state to say if it had stepped out of the contract’s bounds, something that was a “significant and material deficiency in the overall operations” of CCSP, the ombudsman concluded.
Additional sources: Department of Justice, Delaware News Journal, WHYY, WDEL, Bankruptcy Company News
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Related legal case
United States v. Connections Community Support Programs, Inc., et al
| Year | 2021 |
|---|---|
| Cite | USDC, Dist. DE, Case No. 1:21-cv00514-MN |
| Level | District Court |
| Conclusion | Bench Verdict |
| Damages | 13757520.60 |