Edgewater Systems to pay $1.25M for fraudulent Medicaid billing

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Edgewater Systems to pay $1.25M for fraudulent Medicaid billing
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Edgewater Systems for Balanced Living, Inc., in Gary agreed to a $1.25 million pre-suit settlement for fraudulently billing the Indiana Medicaid system for mental health treatment, according to a Friday release from U.S. Attorney Clifford D. Johnson.

Michael LeBroi, chief information officer for Edgewater, referred comment to Danita Johnson, the agency’s president and CEO. She did not return a request for comment.Indiana Medicaid, which receives both state and federal funding, requires providers to draft a care plan for clients receiving mental health counseling services that is signed by either a physician or a health service provider in psychology, a provider with a Ph.D.

Under the False Claims Act such noncompliant billing constitutes a fraudulent claim even though services were in fact rendered. Edgewater has agreed to pay the United States and the State of Indiana $1.25 million for falsely billing Indiana Medicaid for the mental health counseling sessions. Online court records reflect a civil suit filed against Edgewater in April 2017 involving the federal False Claims Act and the Indiana Medicaid False Claims Act.

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