American Psychiatric Centers, Inc., which operates as Comprehensive Psychiatric Services (CPS), has agreed to pay $2.75 million to resolve allegations that it submitted false claims for psychotherapy services to government healthcare programs. The company, based in Walnut Creek, California, provides behavioral medicine services throughout the state.
According to federal authorities, CPS and its providers submitted claims between January 1, 2015, and December 31, 2022, using Current Procedural Terminology codes 90833 and 90836. These are add-on codes meant for use when psychotherapy is provided alongside an evaluation and management visit and require specific documentation. The government alleged that CPS used these codes in situations where services were either not provided or not properly documented.
Of the total settlement amount, $2,615,569.32 will go to the United States and $134,430.68 will be paid to the State of California.
“Providers that participate in federally funded health care programs must abide by the rules and submit proper claims for care that was in fact rendered. To do otherwise is to drain resources from our fellow Americans who rely on Medicare and other government programs. This settlement sends a clear message that we will continue to investigate and pursue any entity that fraudulently seeks to increase profits at taxpayers’ expense,” said United States Attorney Craig H. Missakian.
“Holding health care providers accountable for submitting false claims to Federal health care programs is crucial for ensuring that taxpayer funds are appropriately used and for maintaining the American public’s trust,” said Acting Special Agent in Charge Jeffrey McIntosh of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Working closely with our law enforcement partners, our agency remains dedicated to protecting taxpayer-funded programs that deliver essential behavioral health services.”
“Today’s outcome concludes a collaborative effort to hold Comprehensive Psychiatric Services accountable for its improper billing practices. These actions undermined our Federal health care system, including the Department of Defense’s TRICARE program,” said John E. Helsing, Acting Special Agent in Charge for the Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Western Field Office. “DCIS will continue to work closely with our law enforcement partners and the Department of Justice to investigate health care providers that seek to enrich themselves at the expense of the American taxpayer.”
“Veterans and their families expect and deserve the highest quality healthcare delivered in a safe and accountable setting,” said Special Agent in Charge Dimitriana Nikolov with the Department of Veterans Affairs Office of Inspector General’s Northwest Field Office. “This settlement is a testament to the VA OIG’s commitment to safeguarding the integrity of VA’s healthcare programs and preserving taxpayer funds.”
“False claims increase costs and undermine the integrity of our federal health care programs, including the Federal Employees Health Benefits Program,” said Derek M. Holt, Special Agent in Charge, the U.S. Office of Personnel Management Office of the Inspector General (OPM OIG). “We support the work of our law enforcement partners and colleagues to investigate fraudulent medical billing that wastes taxpayer dollars.”
The matter was handled by Assistant U.S. Attorney Kelsey Helland with assistance from Garland He. Multiple agencies contributed to this investigation: U.S. Attorney’s Office for the Northern District of California; HHS-OIG; DCIS; VA OIG; OPM OIG; as well as California’s Division of Medi-Cal Fraud and Elder Abuse within its Department of Justice.
Officials emphasized ongoing efforts against healthcare fraud using tools like the False Claims Act. Allegations resolved by this agreement remain unproven as there has been no determination of liability.
