Center for Autistic Children Pays $650K to Settle Medi-Cal Fraud Claims Filed in SD

Federal courthouse in downtown San Diego. Photo by Chris Stone

Prism Behavioral Solutions has paid $650,000 to resolve allegations that it billed the state’s Medi-Cal program for services to autistic children without actually providing care to the children, according to a San Diego settlement agreement announced Monday.

Prism provides treatment to children diagnosed with autism and other related disorders through therapy called Applied Behavioral Analysis. The company maintains a corporate address in Woodland Hills and provides services to patients throughout Southern California.

The U.S. government and the State of California alleged that Prism violated the federal False Claims Act and the California False Claims Act by knowingly submitting false claims to Medi-Cal for medical services that Prism Behavioral Solutions did not perform from September 2016 through December 2019.

According to a whistleblower’s complaint, filed in San Diego federal court in 2019, this included Prism Behavioral Solutions billing Medi-Cal for cancelled appointments.

Under the settlement, Prism will pay a total of $650,000 to the state and federal governments, with California receiving a gross share of $390,000. The settlement is based on Prism’s ability to pay, according to the U.S. Attorney’s Office.

“Prism had the important responsibility of supporting and caring for children and young adults with autism spectrum disorders,” said Attorney General Rob Bonta. “Instead of fulfilling its obligation to the families under its care, Prism is alleged to have filed false claims and misused state taxpayer money.”

“These allegations are shameful and these families deserved respect and dignity, not to be used to cheat state resources,” he said. “I am grateful to the U.S. Attorney’s Office for their involvement in this investigation, which helped bring justice to these families and Californiataxpayers. My office will continue to hold accountable bad actors who hurt the health and well-being of Californians.”

The lawsuit was filed by Diana Mason, a licensed board-certified behavioral analyst who was employed by Prism from March 2018 to June 2018, when she observed Prism’s alleged fraudulent activities.

Mason, who did not participate in the misconduct, quit working for Prism because the alleged fraudulent activities continued to occur even after she reported the problems to Prism’s owner. She will receive $78,000 as her share from the California settlement, according to the U.S. Attorney’s Office.

City News Service contributed to this article.