American Psychiatric Centers, Inc., operating as Comprehensive Psychiatric Services (CPS), has agreed to pay $2.75 million to settle allegations that it submitted false claims for psychotherapy services to government healthcare programs. The company is based in Walnut Creek, California, and provides behavioral medicine services across the state.
The government alleged that between January 1, 2015, and December 31, 2022, CPS used certain billing codes—specifically Current Procedural Terminology codes 90833 and 90836—to claim payment for psychotherapy services that either were not provided or were not properly documented. These codes are meant to be used when psychotherapy is performed along with an evaluation and management visit and require specific documentation.
Under the settlement terms, CPS will pay $2,615,569.32 to the United States and $134,430.68 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 case was handled by Assistant U.S. Attorney Kelsey Helland with assistance from Garland He. Multiple agencies took part in investigating this matter: The U.S. Attorney’s Office for the Northern District of California led a coordinated effort involving HHS-OIG, DCIS, VA OIG, OPM OIG, as well as California’s Division of Medi-Cal Fraud and Elder Abuse.
The government emphasized its focus on fighting healthcare fraud using laws like the False Claims Act; these legal tools allow authorities to address suspected fraudulent activities involving public funds.
The allegations resolved by this settlement are civil claims only; there has been no finding or admission of liability.
