In midst of opioid disaster, two R.I. corporations are accused of shortchanging sufferers in restoration

In two latest courtroom instances, one in every of them civil and one in every of them prison, authorities have accused non-public Rhode Island corporations of improperly billing authorities healthcare applications. The unrelated corporations labored in numerous areas of substance use remedy, and authorities are bringing the authorized actions towards them beneath totally different areas of the legislation.

Some suppliers within the state have used this tragedy as a possibility to counterpoint themselves, with out regard for the legislation, authorities allege.

PROVIDENCE — Deadly drug overdoses are staggeringly excessive in Rhode Island proper now, and the demand for drug-addiction remedy has risen together with the loss of life toll.


However the instances largely focus on basically related allegations: wrongfully billing for companies and shortchanging sufferers.

“If we will get in there and each right the conduct and produce some accountability for this, that units down a marker to people who have a look at this specific space of well being care and say, ‘Hey, it’s simple pickings for us to come back in, open up a middle and assist ourselves to federal {dollars}’,” U.S. Legal professional Zachary Cunha mentioned in an interview Wednesday at his workplace. “What we hope to do by transferring shortly and bringing instances like that is to ship the message that no, when you do this, there are going to be penalties.”

Get Rhode Island Information Alerts Signal as much as get breaking information and fascinating tales from Rhode Island in your inbox every weekday. Enter E mail Signal Up

Cunha’s workplace introduced the prison case, introduced in March, and joined the civil case in April. Earlier than changing into the highest federal prosecutor in Rhode Island for the Division of Justice, Cunha had labored on various well being care fraud instances.

“It’s the regrettable actuality that wherever the cash is, and wherever the chance is, somebody goes to attempt to commit fraud and benefit from that,” Cunha mentioned. “And the quicker you will get in there and take motion to carry them accountable for that, the higher off we’re going to be.”


In March, Cunha’s workplace introduced prison prices towards Windfall-based Restoration Connection Facilities of America and two individuals concerned within the office-based opioid remedy program chain, which had areas in Massachusetts and Rhode Island. RCCA is to not be confused with the Massachusetts-based firm with the same identify.

The proprietor and operator Michael Brier, additionally charged within the case, had pleaded responsible to tax evasion in 2013 — however that reality was hid within the firm’s software to take part within the Medicare program, prosecutors mentioned. As investigators inform it, issues at Restoration Connection didn’t get a lot better from that inauspicious begin: falsified data, billing for 45-minute counseling periods that truly lasted two minutes, and Brier telling one witness who’d talked to the feds: “You need to have saved your mouth shut.”

Brier, who was not a health care provider, can be accused of writing prescriptions of Suboxone, a medicine used to deal with opioid use dysfunction. All informed, prosecutors mentioned the defendants enriched themselves with tens of millions in federal and personal healthcare cash they didn’t earn.

Attorneys for RCCA and Brier didn’t reply to requests for remark. A federal decide appointed a court-ordered receiver for RCCA, and sufferers needed to scramble to seek out continued care. The chain had about 1,600 to 1,800 sufferers throughout Rhode Island and Massachusetts.

In a separate case, unveiled late final month, Cunha’s workplace and the workplace of Rhode Island Legal professional Basic Peter Neronha joined a civil lawsuit towards The Journey to Hope, Well being, and Therapeutic, Inc., which was a drug and alcohol remedy supplier with 4 areas in Rhode Island.


In contrast to RCCA, this one may administer methadone, an efficient however tightly regulated remedy used to cut back cravings and withdrawal from different opioids. The federal government alleged in its civil swimsuit that the Journey billed Medicaid for bundled medication-assisted remedy companies despite the fact that it wasn’t offering issues like up to date particular person remedy plans or ample rehabilitative counseling for sufferers. These different companies have been required, the authorities mentioned of their swimsuit.

Dealing with an audit, its administration directed staff to create and backdate paperwork to make it seem to be these remedy plans have been truly being accomplished and up to date and that the counseling was taking place, authorities mentioned.

From January 2015 to July 2021, the Journey acquired greater than $15 million in Medicaid funds for bundled methadone remedy companies. Greater than half have been for sufferers “who weren’t receiving required companies,” the state and federal governments mentioned.

The civil lawsuit was initially filed beneath seal in October 2020 by two whistleblowers who labored for the Journey (which has since been offered and operates beneath new possession and a brand new identify).

The previous CEO of the Journey denied the claims within the lawsuit, by which he’s additionally a defendant.

“We strongly disagree with these allegations and intend to vigorously contest them,” Kenneth L. Richardson Jr. mentioned in an e-mail, including that “each dose of methadone billed was clinically applicable and offered as prescribed.”

Joel Goloskie, lawyer for the Journey, mentioned the federal government shouldn’t have introduced a False Claims Act case over what quantities to “record-keeping lapses and different regulatory shortfalls.”


The civil litigation was filed beneath the False Claims Act, which permits whistleblowers to sue on behalf of the federal government over fraudulent billing; the federal government itself can be part of the lawsuits, which occurred on this case. If profitable, the whistleblowers would share within the restoration.

“Furthermore, the state was nicely conscious of the Journey’s regulatory points, but saved paying as they labored with the Journey to resolve compliance points that plague your complete trade, and come up largely from an ongoing workforce scarcity,” Goloskie mentioned in a written assertion, which is offered in full on-line. “The Journey delivered life-saving methadone, and by no means billed for any week by which such methadone was not delivered.”

(In an interview, Cunha, the highest federal prosecutor, pushed again on the notion that instances like these — he wasn’t commenting on a particular one, however normally — are about record-keeping lapses.)

The individuals who introduced the unique lawsuit have been Sara Quaresma and Michael DelMonico, who labored on the Journey. Their preliminary swimsuit included allegations that Quaresma was intimidated, ridiculed, and threatened with firing after she raised alarms about what she thought-about illegal billing practices with the state. One particular person on the firm, whose identify was redacted in courtroom filings, reportedly warned attendees at a gathering, together with Quaresma, towards “airing the Journey’s soiled laundry.”

There have been hampersful to go round, within the authorities’s telling: Some Medicaid sufferers saved testing optimistic for unlawful medicine, which didn’t immediate elevated companies or consideration, the swimsuit says. A counselor reported that sufferers have been being exploited, with a tradition of tricking individuals into considering companies have been being offered that weren’t. One former supervisor there testified beneath oath that she anxious individuals would die on account of the Journey’s conduct. And one worker there entered 40 nearly-identical counseling notes in per week indicating an hour of counseling had been offered despite the fact that it hadn’t.


When one former worker raised issues with Richardson concerning the Journey’s practices, “Richardson instructed the worker to not report this data to state authorities,” the federal government’s swimsuit mentioned.

“I feel there’s a determined want for” drug dependancy remedy, Louise Herman, the lawyer for the 2 whistleblowers within the civil case, mentioned in an interview. “And I feel that the system is damaged. There’s an actual downside. Aside from greed, I actually don’t know the place it originates.”

Herman mentioned she’s glad the federal government is stepping in to assist.

“We’re wanting ahead to litigating this case with them,” Herman mentioned, “to hopefully tackle this horrific form of apply.”

These instances, in keeping with official suppliers of substance use dysfunction remedy, have forged a harsh gentle on a medical area that already offers with stigma, despite the fact that the allegedly fraudulent ones are nonetheless very a lot within the minority.

“To me, it’s appalling,” mentioned Linda Hurley, CEO of the nonprofit opioid remedy supplier CODAC Behavioral Healthcare who can be the chair of the Opioid Remedy Affiliation of Rhode Island. “It’s actually appalling. Persons are making tens of millions and tens of millions and tens of millions of {dollars}.”

Hurley mentioned the sector does have guardrails — even, in some instances, guardrails which may not at all times be totally mandatory, like requiring annual physicals or recurrently up to date remedy plans that sufferers don’t need or could not truly profit from. However the resolution to guidelines which might be in want of change is to advocate for altering them, to not break them, Hurley mentioned. And these two instances — by which authorities allege not simply corner-cutting however extra basic wrongdoing — gained’t assist the stigma downside, Hurley mentioned.

“I’m offended and annoyed,” Hurley mentioned. “It makes all our jobs a lot more durable.”

The instances have provoked extra than simply consternation. The state Division of Behavioral Healthcare, Developmental Disabilities and Hospitals mentioned in an e-mail that based mostly on these incidents, it’s investigating licensing choices, “with the objective of assuring that purchasers obtain the highest-quality companies.”

“BHDDH is at all times involved when people who’re approved to offer care abuse the belief of their sufferers, households, and the general public,” spokesman Randal Edgar mentioned.

BHDDH licenses behavioral well being remedy services, and the Journey did need to be licensed by BHDDH. Nevertheless it isn’t unusual for teams of independently licensed clinicians to band collectively to kind a enterprise entity. In instances like these it’s not licensed by BHDDH,Edgar mentioned. Restoration Connection was one such case that fell into this regulatory grey zone, Edgar mentioned.

“This is likely one of the areas BHDDH is , to see if different licensing choices would higher guarantee supply of the highest-quality companies,” Edgar mentioned.

Brian Amaral will be reached at Comply with him on Twitter @bamaral44.

Related Post