Provider Of Behavioral Therapy For Children With Autism Spectrum Disorder Agrees To Settle False Claims Act Allegations

Exemplary Behavior, LLC, based in Hendersonville, Tenn., and its principal, Andre Anderson, BCBA, have agreed to pay $20,000 to settle allegations that they violated the False Claims Act, announced Jack Smith, Acting United States Attorney for the Middle District of Tennessee. Exemplary Behavior also operates an office in Clarksville, Tenn.

The alleged conduct involved the submission of false claims for payment to the Defense Health Agency’s TRICARE program for the provision of therapy services, including Applied Behavior Analysis (“ABA”) to children with Autism Spectrum Disorder (“ASD”). Anderson has also agreed to a three-year exclusion from the TRICARE program.

“The TRICARE program covers ABA therapy while most forms of insurance do not, in order to help some of our most deserving yet vulnerable citizens - children who live with and persevere through ASD,” said Acting U.S. Attorney Jack Smith. “This office and its agency partners will diligently pursue both monetary and administrative relief for any violations of federal law that could result in an adverse impact on these children or on the program that funds their treatment.”

Specifically, the settlement resolves allegations by the United States that Exemplary Behavior, through the knowing actions of Mr. Anderson, submitted false claims to TRICARE as a result of their (1) double billing for services rendered; (2) billing for services not rendered by the billing provider; (3) providing group therapy while billing for individual therapy; and (4) billing for services, including ABA therapy, that were not actually provided. The alleged conduct occurred between July 1, 2009, and March 31, 2013.

“This settlement highlights another success demonstrating the continuing commitment of the Defense Criminal Investigative Service (DCIS) to protect the integrity of TRICARE, the Department of Defense health care program,” said Special Agent in Charge of the Southeast Field Office, John F. Khin. “To protect DOD’s limited resources and budgets, DCIS must aggressively investigate fraud, waste, and abuse in our most vulnerable programs to ensure that funds are used properly for our Warfighters, their family members, and military retirees.”

This matter was investigated by the Department of Defense Office of Inspector General, the Federal Bureau of Investigation, and the United States Attorney’s Office for the Middle District of Tennessee. The United States is represented by Assistant U.S. Attorney Christopher C. Sabis.