Case 1:19-cv-00475-CFC Document 10 Filed 06/26/19 Page 1 of 160 PageID #: 328

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF DELAWARE

UNITED STATES OF AMERICA and §

THE STATE OF DELAWARE, ex rel. §
MALIKA SPRUILL and DOUGLAS §
SPRUILL, §
§ C.A. No. 19-cv-475-CFC
Plaintiffs, §
§ FILED UNDER SEAL
v. § PURSUANT TO
§ The False Claims Act
CONNECTIONS COMMUNITY § 31 U.S.C. § 3730(b)(2), and the
SUPPORT PROGRAMS, INC. and § Delaware False Claims and
CATHY DEVANEY MCKAY, § Reporting Act, 6 Del. C.
§ § 1201 et seq.
Defendants. §
§ TRIAL BY JURY OF TWELVE
§ (12) DEMANDED pursuant to
§ F.R.C.P. Rule 38(b) and
§ D. Del. LR 38.1

FIRST AMENDED COMPLAINT

OF COUNSEL: Kyle J. McGee (# 5558)
Laina M. Herbert (# 4717)
Brian Mahany (WI 1065623) GRANT & EISENHOFER P.A.
Tim Granitz (WI 1088934) 123 Justison Street
MAHANYLAW Wilmington, DE 19801
8112 West Bluemound Road Tel: 302-622-7000
Suite 101
Wauwatosa, WI 53213 Attorneys for Plaintiff-Relators
Tel: (414) 258-2375 Malika Spruill and Douglas
Facsimile: (414) 777-0776 Spruill

Date: June 21, 2019

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TABLE OF CONTENTS

SUMMARY OF THE ACTION ................................................................................ 1 

I.  JURISDICTION AND VENUE ......................................................... 19 

II.  THE PARTIES .................................................................................... 21 

III.  FACTUAL BACKGROUND ............................................................. 28 

A.  Connections’ Bill-To Pattern and Practice. ......... 28 

B.  Malika Spruill....................................................... 36 

C.  Dr. Akinlawon Olugbenga Ayeni. ....................... 52 

D.  Fabrication of Medical Records. .......................... 54 

E.  Medically Unnecessary Intake Sessions. ............. 64 

F.  Manipulation of Length of Services Provided to

Meet Arbitrary Billing Targets. ........................... 68 

G.  Dosing Clients Before They Are Seen By A

Physician and A Licensed Provider. .................... 72 

H.  Connections Bills DSAMH and Medicaid for the

Same Claims......................................................... 73 

I.  Connections Submits Claims to Medicare

Knowing Such Claims Will Be Rejected, and Then
Submits the Claims to DSAMH. .......................... 74 

J.  Connections Unbundles Billing Codes to

Fraudulently Increase Reimbursement................. 75 

IV.  GOVERNING LAW ........................................................................... 76 

A.  Medicare ............................................................... 76 

B.  Medicaid ............................................................... 82 

C.  Licensed Clinical Social Worker ......................... 86 

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D.  Federal False Claims Act ..................................... 87 

E.  Delaware False Claims and Reporting Act .......... 89 

ADDITIONAL FALSE CLAIMS ACT AND DELAWARE FALSE CLAIMS

AND REPORTING ACT ALLEGATIONS ........................................................... 91 

COUNT I VIOLATION OF THE FALSE CLAIMS ACT, 31 U.S.C.

§ 3729(A)(1)(A) AGAINST ALL DEFENDANTS .............................................. 100 

COUNT II VIOLATION OF THE FALSE CLAIMS ACT, 31 U.S.C.

§ 3729(A)(1)(B) AGAINST ALL DEFENDANTS .............................................. 103 

COUNT III VIOLATION OF THE DELAWARE FALSE CLAIMS AND

REPORTING ACT, 6 DEL. C. § 1201(A)(1) AGAINST ALL DEFENDANTS 107 

COUNT IV VIOLATION OF THE DELAWARE FALSE CLAIMS AND

REPORTING ACT, 6 DEL. C. § 1201(A)(2) AGAINST ALL DEFENDANTS 110 

COUNT V VIOLATION OF THE FALSE CLAIMS ACT, 31 U.S.C.

§ 3729(A)(1)(A) AGAINST ALL DEFENDANTS .............................................. 113 

COUNT VI VIOLATION OF THE FALSE CLAIMS ACT, 31 U.S.C.

§ 3729(A)(1)(B) AGAINST ALL DEFENDANTS .............................................. 116 

COUNT VII VIOLATION OF THE DELAWARE FALSE CLAIMS AND

REPORTING ACT, 6 DEL. C. § 1201(A)(1) AGAINST ALL DEFENDANTS 120 

COUNT VIII VIOLATION OF THE DELAWARE FALSE CLAIMS AND

REPORTING ACT, 6 DEL. C. § 1201(A)(2) AGAINST ALL DEFENDANTS 123 

COUNT IX VIOLATION OF THE FALSE CLAIMS ACT, 31 U.S.C.

§ 3729(A)(1)(A) AGAINST ALL DEFENDANTS .............................................. 126 

COUNT X VIOLATION OF THE FALSE CLAIMS ACT, 31 U.S.C.

§ 3729(A)(1)(B) AGAINST ALL DEFENDANTS .............................................. 130 

COUNT XI VIOLATION OF THE DELAWARE FALSE CLAIMS AND

REPORTING ACT, 6 DEL. C. § 1201(A)(1) AGAINST ALL DEFENDANTS 135 

COUNT XII VIOLATION OF THE DELAWARE FALSE CLAIMS AND

REPORTING ACT, 6 DEL. C. § 1201(A)(2) AGAINST ALL DEFENDANTS 139 

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COUNT XIII RETALIATION IN VIOLATION OF 31 U.S.C. § 3730(H)(1)

AGAINST ALL DEFENDANTS .......................................................................... 143 

COUNT XIV RETALIATION IN VIOLATION OF 6 DEL. C. § 1208 AGAINST

ALL DEFENDANTS ............................................................................................ 146 

COUNT XV RETALIATION IN VIOLATION OF 31 U.S.C. § 3730(H)(1)

AGAINST ALL DEFENDANTS .......................................................................... 149 

COUNT XVI RETALIATION IN VIOLATION OF 6 DEL. C. § 1208 AGAINST

ALL DEFENDANTS ............................................................................................ 152 

V.  PRAYER FOR RELIEF.................................................................... 154 

VI.  JURY TRIAL DEMANDED ............................................................ 156 

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SUMMARY OF THE ACTION

1. This qui tam civil action seeks to recover monetary losses and

civil penalties on behalf of the United States of America (the “Government”)

and the State of Delaware (“Delaware” or the “State”) against Defendants

Connections Community Support Programs, Inc. (“Connections”) and Cathy

Devaney McKay (“McKay,” and together with Connections, “Defendants”)

pursuant to the False Claims Act, 31 U.S.C. §§ 3729 et seq. (hereinafter

“FCA”), and the Delaware False Claims and Reporting Act, 6 Del. C. §§ 1201

et seq. (hereinafter “DFCRA”), arising from Defendants’ multiple fraudulent

practices, including inter alia, knowingly presenting or causing to be

presented false or fraudulent claims for reimbursement to the Medicare and

Medicaid programs and/or knowingly making, using or causing to be made or

used false records or statements material to false or fraudulent claims to the

Medicare and Medicaid programs for reimbursement that:

a. use Relator Malika Spruill’s (“Ms. Spruill’s”) unique National

Provider Identifier (“NPI”), which are designed to state or imply

that Ms. Spruill, a licensed clinical social worker (“LCSW”),

provided or supervised the provision of the services to

Connections’ clients, notwithstanding that, in fact, unlicensed

and unsupervised providers, who are not entitled to bill for their
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services, provided these services, in an attempt to cause, and in

fact causing, the Government and Delaware to pay out more

money than they owe for these services;

b. use Dr. Akinlawon Olugbenga Ayeni’s (“Dr. Ayeni”) NPI,

which are designed to state or imply that Dr. Ayeni, a physician,

provided or supervised the provision of the services to

Connections’ clients, notwithstanding that, in fact, unlicensed

and unsupervised providers, who are not entitled to bill for their

services, provided these services, in an attempt to cause, and in

fact causing, the Government and Delaware to pay out more

money than they owe for these services;

c. concealed that Defendants fabricated medical records, including

that physicians’ incomplete medical records were completed by

Connections’ personnel months after the fact without any

background or knowledge as to the clients’ condition or

treatment provided; recovery plans were submitted several

months late and were “completely wrong and could cause issues

with an audit;” information for one client was scanned into

another client’s chart; Connections’ employees were ordered to

“fraudulently sign[] documents and/or add[] unknown

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milligrams of medications on documents;” multiple HIPPA

violations; and Connections’ employees knew the status of

Connections’ documentation was “not good!”;

d. concealed the whirlwind of fraudulent activity at Connections

prior to external audits whereby Defendants attempted to hide

hundreds of unsigned documents,” including “the recovery

plans, which [were] clearly out of compliance;” McKay’s orders

to “just start signing” unsigned documents despite knowing

“they are not all correct;” orders to clean up the charts “scattered

across the floors and around the desks” and “under desks, on the

floor, in drawers, etc.” and to conceal the fact that Connections’

staff lacked the necessary training and certifications to comply

with the Division of Substance Abuse and Mental Health’s

(“DSAMH”) requirements and other regulations;

e. concealed medically unnecessary intake sessions designed to

increase Connections’ profits;

f. concealed that Defendants manipulated the length of services

Connections provided by seeking reimbursement for more time

than they actually spent with clients, Connections’ providers

double-booked clients and fabricated their schedules to make it

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look like providers were seeing clients after they had clocked out

and left the facility -- all to reach arbitrary billing targets

designed to increase Connections’ bottom line;

g. concealed that Defendants dosed clients before they were seen

by Connections’ doctors and licensed counselors and billed

clients, i.e. Medicaid, Medicare or DSAMH, for the clients’

dosing at the clinics when they were not;

h. concealed that Connections bills and is reimbursed by DSAMH

and Medicaid for the same claims;

i. concealed that Connections submits claims to Medicare knowing

such claims will be rejected, and then submits the claims to

DSAMH; and

j. concealed that Connections unbundled Intensive Outpatient

Program (“IOP”) services when it fails to provide the minimum

required nine hours of weekly contact to increase its

reimbursement.

Defendants’ Improper Use of Ms. Spruill’s NPI

2. Any use of Ms. Spruill’s NPI to make or submit claims for

reimbursement to Medicare or Medicaid for professional services she did not

personally perform, and not personally performed by staff members that Ms.

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Spruill’s supervised, is unlawful and causes the Government and Delaware to

overpay Connections. This case challenges Defendants’ use of fraudulent

practices to divert federal and State funds via the Medicare and Medicaid

programs -- funds desperately needed to effectively combat grave societal

problems such as the prevalence of substance use disorders in Delaware and

the opioid epidemic in particular -- to their own pockets. As alleged in more

detail below, Relators Ms. Spruill and Mr. Spruill (collectively, “Relators”)

possess documentary evidence of Connections’ practice of making or

presenting false claims using Ms. Spruill’s NPI to obtain Government and

State funds to which it was not entitled.

3. Under the applicable rules, Ms. Spruill was permitted to submit

or cause to be submitted, under her NPI, claims for professional services she

personally provided to Medicare or Medicaid beneficiaries. Moreover, a

limited set of individuals supervised by Ms. Spruill were permitted to submit

or cause to be submitted, under Ms. Spruill’s NPI, claims for professional

services such individuals provided under Ms. Spruill’s supervision to

Medicaid beneficiaries. This case is not about such claims.

4. Ms. Spruill supervised the following unlicensed staff in the

Dover clinic, and therefore, these individuals were permitted to bill Medicaid

for services they performed under Ms. Spruill’s supervision using Ms.

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Spruill’s NPI: Alyssa Lucas (“Lucas”), a Counselor II to Counselor I who

became a Certified Alcohol and Drug Counselor (“CADC”); Alex Cropper

(“Cropper”), a Counselor I and CADC; Shaneka Geipel (“Geipel”), a

Counselor I who became a CADC; Cat Montefusco (“Montefusco”), a

Counselor II to Counselor I who became a CADC; Roderick Anderson

(“Anderson”), a Counselor II; Edwin Motten (“Motten”), a Counselor II;

Johanna Truax (“Truax”), a Master’s level Counselor II; Devon Duker Hanzer

(“Hanzer”), a Counselor II; Diara Miller (“Miller”), a Counselor II; and Jarrett

Cagel (“Cagel”), a Counselor II. After the rules changed, CADCs were

permitted to bill Medicaid directly, and should have done so.

5. Ms. Spruill also supervised certain staff in Connections’ Smyrna

clinic from August 2015 through January 2016, and two individuals in the

Wilmington clinic, including Heather Emmerick (“Emmerick”), a CADC in

the Smyrna clinic, and Theresa Sharp (“Sharp”) in the Wilmington clinic. All

of the individuals Ms. Spruill supervised during this time in the Smyrna and

Wilmington clinics had Master’s degrees, and should have billed under

CADC rates.

6. Moreover, under the applicable rules, if other LCSWs, Licensed

Professional Counselors of Mental Health (“LPCMHs”) or Licensed Marriage

and Family Therapists (“LMFTs”) submitted or caused to be submitted claims

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for professional services that they personally provided to Medicaid

beneficiaries under Ms. Spruill’s NPI, Medicaid would have reimbursed

Connections the same amount as if Ms. Spruill had personally performed

those services. Therefore, although this practice is inappropriate (because

such licensed professionals are not authorized to use Ms. Spruill’s NPI), the

Government and Delaware would have paid Connections the same amounts

they would have paid in the event such licensed professionals used their own

NPIs. Accordingly, Ms. Spruill does not seek damages for claims submitted

by or on behalf of LCSWs, LMFTs or LPCMHs for services personally

performed by these LCSWs, LMFTs or LPCMHs, and submitted to Medicaid

for reimbursement under Ms. Spruill’s NPI.

7. Relators seek recovery of damages suffered by the Government

and Delaware as a result of claims for reimbursement submitted to Medicare

or Medicaid by or on behalf of unlicensed, un-credentialed or lower-level

individuals who Ms. Spruill never supervised, or who Ms. Spruill was not

supervising at the time they used Ms. Spruill’s NPI to submit claims for

reimbursement to Medicaid, including but not limited to the following:

a. any Connections’ staff who worked in the Harrington clinic, as

Ms. Spruill never supervised any staff in the Harrington clinic;

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b. any staff in the Newark clinic from August 2013 through October

6, 2014, as Ms. Spruill was not a supervisor while she was

working in the Newark clinic during this period; and

c. any staff other than (i) Lucas, Cropper, Geipel, Montefusco,

Anderson, Motten, Truax, Hanzer, Miller, or Cagel in the Dover

clinic; (ii) staff under Ms. Spruill’s supervision in the Smyrna

clinic from August 2015 to January 2016; and (iii) staff under

Ms. Spruill’s supervision in the Wilmington clinic from August

2015 to January 2016.

8. Medicare does not reimburse, inter alia, CADCs, Certified

Social Workers, Drug and Alcohol Rehabilitation Counselors, Licensed

Alcoholic and Drug Counselors (“LADCs”), Licensed Professional

Counselors (“LPCs”), LMFTs, persons holding a Masters of Social Work, or

Mental Health Counselors. Thus, Ms. Spruill also seeks damages for claims

for reimbursement submitted to Medicare by or on behalf of CADCs,

Certified Social Workers, Drug and Alcohol Rehabilitation Counselors,

LADCs, LPCs, LMFTs, persons with a Masters of Social Work or Mental

Health Counselors using Ms. Spruill’s NPI regardless of whether Ms. Spruill

supervised them.

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9. Medicare does not authorize LCSWs to bill for services

furnished as an incident to their own processional services. In other words, a

LCSW may not bill Medicare for services s/he orders as part of an active

treatment plan that are integral, although an incidental part of the LCSW’s

professional service, and are furnished by another individual under the

LCSW’s direct supervision. Thus, Relators also seek damages for claims for

reimbursement submitted to Medicare by or on behalf of unlicensed, un-

credentialed individuals who used Ms. Spruill’s NPI to submit claims for

reimbursement to Medicare.

10. Although Relators’ complaint alleges the improper use of Ms.

Spruill’s NPI by unlicensed providers Ms. Spruill did not supervise, the

practice of Connections’ unlicensed and unsupervised employees and agents

using licensed qualified healthcare providers’ NPIs for Medicare and

Medicaid billing purposes is not limited to Ms. Spruill, but extends to several

of Connections’ other licensed qualified healthcare providers.

Defendants’ Improper Use of Dr. Ayeni’s NPI

11. This qui tam action also seeks to recover monetary losses and

civil penalties on behalf of the Government and Delaware against Defendants

pursuant to the FCA and the DFCRA arising from Defendants’ practice of

knowingly presenting or causing to be presented false or fraudulent claims for

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reimbursement and/or knowingly making, using or causing to be made or used

false records or statements material to false or fraudulent claims to federal

Medicare and state Medicaid for reimbursement that use Dr. Ayeni’s NPI,

which are designed to state or imply that Dr. Ayeni, a physician, provided the

services to Connections’ clients or supervised the provision of these services,

notwithstanding that, in fact, unlicensed and unsupervised providers, who are

not entitled to bill for their services, provided the services to Connections’

clients, in an attempt to cause, and in fact causing, the Government and

Delaware to pay out more money than they owe for these services.

12. Additionally, Connections knowingly billed the Government,

through its federal Medicare and state Medicaid programs and Delaware’s

DSAMH program, for services purportedly provided by Dr. Ayeni using his

NPI, despite that these services were not performed by Dr. Ayeni, or

supervised by Dr. Ayeni. Instead, these services were provided by

Connections’ unlicensed agents or employees who are not entitled to bill for

reimbursement from Medicare and/or Medicaid, unless properly supervised.

Such action was designed to state or imply that Dr. Ayeni provided these

services and/or supervised the provision of these services to Connections’

clients, which is untrue.

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13. Defendants have engaged in at least the following further

schemes to defraud the Government and Delaware.

Defendants’ Fabrication of Medical Records

14. Connections must comply with all of the conditions and

requirements set by Medicaid, Medicare and DSAMH, including but not

limited to submitting reimbursement for services that were actually provided

to the clients, services that were medically necessary and correctly coding

those services when submitting a claim. As described herein, when physicians

fell behind on recordkeeping, or were terminated, their records were

completed months later by Connections’ employees who had no information

on the clients’ underlying conditions or the treatment provided. Connections’

providers not only submitted late and incomplete records, but they were so

inaccurate that Ms. Spruill refused to sign many of them. Other employees

were ordered to “fraudulently sign[] documents and/or add[] unknown

milligrams of medications on documents (because the client hadn’t done so).”

This case challenges, and Relators possess documentary evidence of,

Connections’ practice of making or presenting false claims using these

fabricated medical records.

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Defendants Conceal Their Noncompliance From External

Auditors

15. When faced with external audits by officials who could put

Connections out of business, Defendants covered up their noncompliance by

hiding the hundreds of unsigned documents in their records and cleaning up

the “under desks, on the floor, in drawers, etc.” and scurrying to get locks for

cabinets that were required to be locked. This case challenges Connections’

noncompliance with Medicaid, Medicare and DSAMH’s requirements despite

the appearance that it did when audited. As described in detail herein and in

the documentary evidence Relators possess, by way of example only, Mr.

Spruill notified his superiors that the Harrington clinic was out of compliance

in multiple areas. Six months later, Connections took corrective action against

Mr. Spruill by offering him a demotion, severance package or termination,

and seven months later, terminated him.

Defendants Conceal Medically Unnecessary Intake Sessions

Designed to Increase Connections’ Profits

16. According to the Manual (defined below), Connections is to be

reimbursed at predetermined rates for providing specific, medically-necessary

alcohol and drug treatment services. Connections requires its new clients to

participate in an intake session so providers may determine the level of

services each client should receive. When current Connections’ clients, who

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are receiving medication-assisted therapy (“MAT”) services for opioid

addiction, miss three consecutive days of dosing, Connections requires them

to submit to another intake, rather than allowing them to speak with an on-call

physician. These medically-unnecessary intakes are usually conducted at the

Harrington clinic because it is the only clinic that offers around-the-clock

intakes, at the cost of $337.27. Following this intake, clients are returned to

their “home” clinic and treatment continues as it did prior to the intake. As

described herein, this case challenges these fraudulent, medically unnecessary

intakes and the “23-hour” program that follows, which serve only to increase

Connections’ bottom line.

Defendants’ Improperly Manipulated the Length of Services

Connections Provided to Clients
17. When Connections submits claims for reimbursement for MAT

services, it is representing that the client was seen for the amount of time that

it billed for. Not so. As described herein and in Relators’ documentary

evidence, Connections billed Medicare, Medicaid and DSAMH for the

maximum time allowed for each service regardless of whether Connections’

providers actually saw the client for that amount of time, or the minimum

required time to submit the claim. In addition, Connections’ providers

double-booked clients and fabricated records to make it appear they were

seeing clients after they had clocked out and left the facility. This case

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challenges these fraudulent practices that were designed to reach arbitrary

billing targets created to increase Connections’ bottom line.

Connections Doses Clients Before They Are Seen by a Physician

and a Licensed Provider
18. This case challenges Connections’ practice of dosing clients

before they are seen by a doctor and a licensed counselor, and submitting

claims for reimbursement as if they have been seen by such providers. As

described herein and in Relators’ documentary evidence, dosing clients before

they go through Connections’ intake procedure and are seen by both a doctor

and a licensed counselor is against Connections’ policy. Or, in Ms. Spruill’s

words: “Ridiculous!” “This CAN’T Happen! Clients cannot be dosing with

us for 2 months with us not seeing them!!!! If this person died on our watch,

we would be screwed!!! Unacceptable!”

Connections Bills and Is Reimbursed By DSAMH and Medicaid for

the Same Claims

19. As described herein, this case challenges Connections’ practice

of submitting a claim to DSAMH for reimbursement for services provided to

uninsured clients, enrolling the uninsured client in Medicaid and then

submitting the same claim for reimbursement to Medicaid. Ultimately,

Connections receives and pockets reimbursement from both DSAMH and

Medicaid for these claims.

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Connections Submits MAT Claims to Medicare Knowing Such

Claims Will Be Rejected Before Submitting Them to DSAMH

20. This case challenges Connections’ standard practice of

submitting claims for MAT services to Medicare knowing such claims will be

denied. After Medicare denies these claims, Connections submits them to

DSAMH for reimbursement relying on DSAMH’s coverage of necessary

treatment not otherwise covered by alternative sources. While Medicare

suffers no loss (other than wasted resources rejecting the claim), this practice

constitutes submission or presentment of a false claim.

Connections Unbundles IOP Services to Increase Reimbursement

21. To be reimbursed for IOP services, Connections must provide

between nine and nineteen hours of contact per week, with a minimum of

three contact days per week. This case challenges Connections’ practice of

maximizing its reimbursement when it fails to provide nine hours of contact

per week by unbundling IOP services and billing for them on a per unit basis,

rather than a per diem basis. Again, all in the name of generating more money

for Connections’ bottom line.

22. Defendants’ actions, as described herein, divert government

funds -- paid by federal and Delaware taxpayers -- for health benefits to low

income individuals and families, to themselves. Thus, Defendants’ actions

directly deprive Delaware of money it needs desperately to fight significant

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societal ills, such as substance use disorders and the opioid epidemic in

particular, and rob Delaware’s most vulnerable citizens of resources

designated for their treatment. Indeed, as Connections provides substance use

disorder treatment, Defendants’ fraudulent submissions of claims for

reimbursement directly capitalizes on the ongoing opioid epidemic.

23. In 2016, throughout the United States:

 116 people died every day from opioid-related drug overdoses;

 2.1 million people had an opioid use disorder;

 948,000 people used heroin – 170,000 for the first time;

 11.5 million people misused prescription opioids – 2.1 million for the
first time;

 17,087 deaths were attributed to overdosing on commonly-prescribed

opioids;

 19,413 deaths were attributed to overdosing on synthetic opioids other

than methadone;

 15,469 deaths were attributed to overdosing on heroin;

 Totaling $504 billion in economic costs.

24. In 2017, throughout the United States:

 More than 130 people died every day from opioid-related drug
overdoses;

 Drug overdose deaths involving any opioid―prescription opioids

(including methadone), synthetic opioids, and heroin―rose from
18,515 deaths in 2007 to 47,600 deaths in 2017;

 17,029 deaths were attributed to overdosing on prescription opioids;

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 28,400 deaths were attributed to overdosing on synthetic narcotics; and

 15, 482 deaths were attributed to overdosing on heroin.

25. The opioid crisis has had, and continues to have, a devastating

impact on Delaware. The Delaware Department of Health and Social Services

(“DHSS”) reported “[t]here were at least 291 deaths [in 2018] in Delaware

from suspected overdoses. Tragically, the final number is expected to exceed

400 after all toxicology screens are finished (they take six-eight weeks) and

final death determinations are made on outstanding cases by the Division of

Forensic Science. The Centers for Disease Control and Prevention ranked

Delaware as number six in the nation for overdose deaths in 2017.” As of

June 16, 2019, DHSS reported 110 suspected overdose deaths in 2019.

26. According to the Centers for Disease Control and Prevention,

Delaware had the sixth highest increase in overdose deaths from 2015 to 2016

in the nation, with a 40% increase in drug overdose deaths in 2016. Between

2016 and 2017, Delaware’s drug overdose death rate increased 20.1%.

27. When measured using emergency room and hospital billing data,

Delaware’s opioid overdose rate increased by 105% -- or more than three

times the average of the 16 states participating in the Enhanced State Opioid

Overdose Surveillance program -- from the third quarter of 2016 to the third

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quarter of 2017. Delaware’s increase over this period was higher than any of

the 16 other participants, other than Wisconsin.

28. In 2016, Delaware lost over 300 lives to overdose, 143 of these

deaths were due to opioids. The year before, in 2015, Delaware ranked third

in the United States in per-capita health care costs from opioid abuse, and

spent approximately $109.4 million in health care costs battling this crisis.

This staggering cost does not include the financial impact of the opioid

epidemic on Delaware’s’ criminal justice system, social services, and

educational resources.

29. The Delaware Department of Justice has consistently highlighted

the need “for Delaware to fund more treatment opportunities [in the areas of

long-term residential treatment and sober living facilities] for those

Delawareans with substance use disorder who are willing to seek treatment.”

30. Facing an uphill battle, DSAMH’s approximately $24 million

budget for addressing addiction and behavioral health does not stretch nearly

far enough. And, DHSS’s Fiscal Year 2019 budget includes $990,000 for

SUD assessment and referral to treatment of people who have overdosed or

are suffering from addiction, and have been brought to emergency rooms. It

also includes $328,500 for 20 additional sober living beds, and $100,000 for

naloxone.

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31. Connections holds itself out as Delaware’s largest behavioral

health provider, and is one of two Delaware treatment providers recently

named to lead the Delaware Substance Use Treatment and Recovery

Transformation (START) Initiative, which has been tasked with tackling

access to treatment and navigating recovery from addiction.

32. Defendants’ conduct, as described herein, has allowed

Connections to pocket enormous reported revenues (approximately $102

million in 2016 alone) under the guise of its nonprofit status, at the expense

of vulnerable Delawareans.

33. Defendants are and should be required to abide by the current

Medicare and Medicaid billing requirements, rather than being rewarded with

additional funding from new Delaware initiatives at a time when more than

one million additional budget dollars are being devoted to fight this epidemic.

I. JURISDICTION AND VENUE

34. This Court has subject matter jurisdiction over this action

pursuant to 31 U.S.C. §§ 3730, 3732.

35. The Court has personal jurisdiction over Defendants pursuant to

31 U.S.C. § 3732(a), which authorizes nationwide service of process, and

because one or all of the Defendants can be found, resides or transacts

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business in this District. Specifically, Connections is incorporated in the State

of Delaware, and maintains headquarters in Wilmington, Delaware.

36. Venue is proper in this District pursuant to 31 U.S.C. § 3732(a)

because Defendants transact business in this District.

37. This suit is not based upon the prior public disclosure of the

allegations or actions in a criminal, civil, or administrative hearing, or from

the news media. This suit is also not substantially based upon allegations or

transactions, which are the subject of a civil suit or an administrative

proceeding which the Government or Delaware is already a party.

38. To the extent that there has been a public disclosure unknown to

Relators, they are an original source of the information under 31 U.S.C.

§ 3730(e)(4) and 6 Del. C. § 1206(c). Relators have direct and independent

knowledge of the information on which the allegations are based, and

pursuant to 31 U.S.C. § 3730(e)(4) and 6 Del. C. § 1206(c), voluntarily

provided the information to the United States Attorney General, the United

States Attorney for the District of Delaware, and the Attorney General of the

State of Delaware before filing this qui tam action.

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II. THE PARTIES

39. Relator Malika Spruill (“Ms. Spruill”) is a resident of

Middletown, Delaware, and has knowledge of the factual allegations

contained herein.

40. Relator Douglas Spruill (“Mr. Spruill”) is a resident of

Middletown, Delaware, and has knowledge of the factual allegations

contained herein.

41. Mr. Spruill worked at Connections in various positions from

2002 through 2007, and again from January 2013 until he was terminated

improperly in June 2019. In June 2019, Mr. Spruill was the Site Director of

the Harrington clinic.

42. Defendant Connections is incorporated in Delaware, and its

registered agent is Catherine DeVaney McKay, 3821 Lancaster Pike,

Wilmington, Delaware 19805.

43. Connections operates an outpatient medical and mental health

clinic in Wilmington, and provides integrated mental health, substance abuse

treatment, and primary care at its clinics in Newark, Smyrna, Dover,

Harrington, and Millsboro. It also has a satellite site in Seaford. Connections

claims its “clinics are staffed by physicians, nurse practitioners, psychiatrists,

therapists, nurses and other health care and counseling professionals.”

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44. Connections operates in more than 100 separate locations in

Delaware, and provides primary care, mental health, substance abuse and sex

offender treatment to more than 35,000 Delawareans, including all of the

individuals who are incarcerated in Delaware’s unified correctional system.

45. In 2016, Connections became the provider of medical, mental

health care and addiction treatment to the Caroline County Detention Center

in Denton, Maryland.

46. Today, Connections is one of Delaware’s largest nonprofit

organizations that “assists people with psychiatric and intellectual disabilities,

as well as those with substance use disorders, homeless veterans and their

families, families in crisis, and men and women who are incarcerated.”

47. Connections has more than 1,700 full-time employees who serve

more than 42,000 people each year.

48. Connections’ current strategic plan calls for it to explore

opportunities in nearby states.

49. In response to the nation’s deadly opioid epidemic, Connections

partnered with DSAMH, the City of Harrington, and the USDA to open

Connections Harrington Withdrawal Management Center Inpatient and

Outpatient Services (“Harrington”). This clinic “is the primary place where

residents of Kent and Sussex Counties receive safe and secure, medically

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monitored withdrawal management services and treatment.” Harrington also

provides support to those who are withdrawing from alcohol and other drugs.

In addition, Connections operates sober living homes, the Women’s

Residential Treatment Center, New Expectations (a residential program for

pregnant, justice-involved women with substance abuse issues who are facing

incarceration), and DUI treatment programs.

50. As of November 18, 2016, DSAMH reported the following

licensure and Medicaid Certification information for twenty-nine of

Connections’ substance abuse and mental health programs in Delaware:

PROVIDER INFORMATION LICENSURE/CERTIFICATION

STATUS

(L=License; C=Certification; P=
Provisional)

Connections, ACT — Dover (Paul's Full C

Team)
Carroll's Plaza - 1114 South DuPont Provides services for persons with
Highway, Suite # 103 psychiatric disabilities.
Dover, DE
19901 302-336-8307

Connections CSP ACT I Full C

1423 Capitol Trail, Polly Drummond
Office Plaza, Suite 3302 2nd Floor Provides services for persons with
Newark, DE 19711 psychiatric disabilities.
302.894-7900

Connections CSP ACT II Full C

500 W 10th Street
Wilmington, DE 19801

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302.230.9102 Provides services for persons with

psychiatric disabilities.

Connections CSP ACT III Full C

2126 West Newport Pike, Suite 201
Wilmington, DE 19804 Provides services for persons with
302.304.3350 psychiatric disabilities.

Connections CSP ACT IV Full C

1423 Capitol Trail, Polly Drummond
Plaza, (Bldg. #3) (2nd Floor) 3202 Provides services for persons with
Newark, DE 19711 psychiatric disabilities.
302-428-9200

Connections CSP ACT V Full C

801 West Street
Wilmington, DE 19801 Provides services for persons with
(302) 232-5490 psychiatric disabilities.

Connections CSP ACT (Paul's Team) Full C

621 W. Division St.
Dover, DE 19901 Provides services for persons with
302.672.9360 psychiatric disabilities.

Connections CSP (AOD) Full L

2205 Silverside Road, Suite 5
Wilmington, DE 19810 Provides outpatient DUI
302.984.3380 Treatment.

Connections CSP ACT IV New Castle Full L

1423 Capitol Trail, Polly Drummond
Office Plaza, Suite 3302 Provides services for persons with
Newark, DE 19711 302.379.4174 psychiatric disabilities.

Connections CSP Brandywine St. Full L

Women's Residential Treatment
Program Provides Residential Services.
822 North West Street
Wilmington, DE 19802
1-866-477-5345
Connections CSP AOD Dover Full L
(Outpatient)

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Carroll's Plaza located at 1114 South Provides Outpatient Treatment

DuPont Highway Services.
Dover, DE 19901
1-866.477.5345
Connections CSP (Opioid Treatment Full L
Program)
Carroll's Plaza located at 1114 South Provides medicated assistance
DuPont Highway, treatment in an outpatient setting.
Dover, DE 19901
1-866.477.5345
Connections Residential Detox Full L/Contracted
1-11 East Street, Spartan Station
Shopping Center Residential Detoxification
Harrington, DE 19952 Services
1-866.477.5345
Outpatient Treatment Services

Opioid Treatment Services.

Connections AOD Millsboro (Outpatient Full L

Treatment)
315 Old Landing Road Provides Outpatient Treatment
Millsboro, DE 19966 Services.
1-866.477.5345
Connections AOD Millsboro (Opioid Full L
Treatment)
315 Old Landing Road Provides Opioid Treatment
Millsboro, DE 19966 Services.
1-866.477.5345
Connections Millsboro (Co-Occurring New Provisional License
Treatment)
315 Old Landing Road Provides Co-Occurring Treatment
Millsboro, DE 19966 Services.
1-866.477.5345
Connections CSP (Opioid Treatment Full L
Program)
3304 Polly Drummond Office Plaza, Provides medicated assistance
Newark, DE 19711 treatment.
1-866.477.5345
Connections CSP (AOD Outpatient) Full L

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3304 Polly Drummond Office Plaza, Provides Outpatient Treatment

Bldg. 3 Services.
Newark, DE 19711
1-866.477.5345
Connections (Outpatient Treatment) Full L
Smyrna
320 High Street Provides Outpatient Treatment
Smyrna, DE 19977 Services.
1-866.477.5345
Connections (Opioid Treatment) Smyrna Full L
320 High Street
Smyrna, DE 19977 Provides Opioid Treatment
1-866.477.5345 Services.

Connections North Wilmington Full L

2205 Silverside Road, Suite 5,
Wilmington, DE 19810 Provides DUI Outpatient
1-866.477.5345 Treatment Services.

Connections (Co-Occurring Treatment) New Provisional License

Wilmington
801 West Street Provides Co-Occurring Treatment
Wilmington, DE 19810 Services.
1-866.477.5345
Connections CSP Blackbird Landing Full C
Group Home
994 Blackbird Landing Road Group homes for people with
Townsend, DE 19734 psychiatric disabilities.
1-866.477.5345
Connections CSP Camden Group Home Full C
124 N West Street
Camden, DE 19934 Group homes for people with
1-866.477.5345 psychiatric disabilities.

Connections CSP Cardinal Group Home Full C

722 Cardinal Ave
Bear, DE 19701 Group homes for people with
1-866.477.5345 psychiatric disabilities.

Connections CSP Clint Walker Group Full C

Home

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676 Black Diamond Rd Group homes for people with

Smyrna, DE 19977 psychiatric disabilities.
1-866.477.5345
Connections CSP Gordy Place Group Full C
Home
204 Gordy Place Group homes for people with
New Castle, DE 19720 psychiatric disabilities.
1-866.477.5345
Connections CSP Roxanna Group Homes Full C
35906 Zion Church Rd.
Frankford, DE 19945 Group homes for people with
1-866.477.5345 psychiatric disabilities.

Connections CSP Still Road Group Home Full C

2197 Still Road
Camden, DE 19934 Group homes for people with
1-866.477.5345 psychiatric disabilities.

51. In 2016, Connections earned $102,045,443 in reported revenues,

53% of which derives from the Delaware Department of Corrections; 15%

from “other fees for service;” 14% from Delaware Health and Social Services;

13% from Medicaid; 5% from HUD; and 1% from contributions and grants.

52. Defendant McKay is Connections’ founder, chief executive

officer and president. McKay is a licensed associate marriage and family

therapist, and has worked as a therapist and supervisor, and in the behavioral

health industry since 1977.

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III. FACTUAL BACKGROUND

A. Connections’ Bill-To Pattern and Practice.

53. Medicare and Medicaid reimburse, inter alia, physicians and

LCSWs at a higher rate than they reimburse many other providers. While

Medicaid permits an employee who is supervised by a LCSW to bill under

that LCSW’s NPI, Medicare does not. Therefore, Connections has an

incentive to submit claims for reimbursement under a LCSW’s NPI to

fraudulently maximize the amount of reimbursement it receives from

Medicare and Medicare.

54. Similarly, when a non-LCSW or non-physician performs

services on a Medicare client, Connections has three options: (a) not bill

Medicare for the services because Medicare only reimburses LCSWs and

physicians; (b) submit the claim to Medicare for reimbursement under the

provider’s NPI knowing Medicare will reject the claim, and then seek

reimbursement from DSAMH; or (c) bill under Ms. Spruill or another

LCSW’s (or a physician’s) NPI, as if Ms. Spruill, a LCSW or a physician

performed the services. Connections is only reimbursed for its services under

the third option.

55. Connections instructs its LCSWs to sign off on services they did

not provide and work they did not supervise for reimbursement purposes,

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despite Medicaid, Medicare and other managed care organizations

reimbursing work done by different practitioners at different rates. For

example, at a meeting attended by Ms. Spruill, McKay, Jevon Hicks, Sr.

(“Hicks”), Connections’ Director of Billing and Medical Records, Melissa

Schneck (“Schneck”), Mohamed, Angie Walker (“Walker”) and Bill Northey

(“Northey”), McKay reported that United Healthcare was requiring LCSWs

to supervise all counselors, and instructed the LCSWs that they must sign off

on the counselor’s work. At this meeting, the attendees raised the issue of

different practitioners being reimbursed by Medicaid, Medicare and other

managed care organizations at different rates, based on their licensing and

qualifications. In response, McKay insisted that United Healthcare would

only accept LCSW-reviewed work from any counselors that were providing

services. Someone at this meeting asked about Highmark Delaware Health

Options’ (“Health Options”) practices for reimbursing providers, and McKay

and Hicks replied that it was easier for LCSWs to sign off on everything to

make it less confusing.

56. When any Connections employee, whether they be licensed or

unlicensed, enters medical notes and/or other information into Connections’

Electronic Healthcare Records system (“EHR”), EHR automatically

populates the “bill to” person’s name with the name of the person who is

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entering the information into EHR. Connections’ providers are instructed by

management to change the “bill to” person to the Licensed Clinician at the

clinic where the services were provided by selecting the designated name from

a list of populated names from a drop-down menu.1 If a provider fails to select

the designated “bill to” person, then the billing staff and Connections’ billing

system, CareLogic, will reject that claim, and it will not be sent out for billing

to the managed care organization. Connections requires a LCSW to be

selected as the “bill to” person, despite that the LCSW did not provide the

services or supervise the provision of the services.

57. According to the Delaware Adult Behavioral Health Service

Certification and Reimbursement Provider Specific Policy Manual (Nov. 1,

2016) (the “Manual”), substance use disorder services (SUDs) may be

provided by “licensed and unlicensed professional staff, who are at least

18 years of age with a high school or equivalent diploma, according to their

areas of competence as determined by degree, required levels of experience

as defined by State law and regulations and departmentally approved program

guidelines and certifications.”

1
Ex. 1 (1/24/18 10:04 am email from Jevon Hicks to Johanna Truax
copying Lisa Clark and Malika McMeans-Spruill re: Billing errors).

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58. Service providers employed by addiction and/or co-occurring

treatment services agencies, i.e. Connections, must work in a program

licensed by DSAMH, comply with all relevant licensing regulations, and

maintain their individual provider licenses.

59. Licensed practitioners who may bill Medicaid for SUDs under

Delaware regulation are licensed by Delaware, and include, but are not limited

to LCSWs, LPCMHs and LMFTs, Nurse Practitioners (“NPs”), Advanced

Practice Nurses (“APNs”), medical doctors (MDs and DOs), psychologists,

and as of July 1, 2016, Licensed Chemical Dependency Professionals

(“LCDPs”) and CADCs. Delaware licensure of practitioners does not drive

Medicaid reimbursement. For example, RNs are licensed, but not entitled to

reimbursement from Medicaid, and are therefore grouped with “unlicensed

staff.”

60. Under Delaware Medicaid, reimbursement for services,

including crisis intervention services, outpatient addiction services and

residential treatment services, are based upon a Medicaid fee schedule

established by Delaware. According to the Methods and Standards For

Establishing Payment Rates For Other Licensed Behavioral Health

Practitioners: “If a Medicare fee exists for a defined covered procedure code,

then Delaware will pay Psychologists at 100% of the Medicaid physician rates

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as outlined under Attachment 4.19-B, item 5 [to the State Plan Under Title

XIX of the Social Security Act State/Territory: Delaware].” If a Medicare fee

exists for a defined covered procedure code, then Delaware Medicaid will pay

LCSWs, LPCMHs and LMFTs at 75% of the Medicaid physician rates as

outlined under Attachment 4.19-B, item 5.

61. Licensed practitioners, such as psychologists, LCSWs, LPCMHs

and LMFTs may bill Medicaid for eligible outpatient SUDs and for non-

physician Licensed Behavioral Health Practitioner (“LBHP”) codes.

62. According to the Manual, “unlicensed staff,” e.g. certified peers,

will bill “using their licensed supervisor as the rendering provider number.”

63. Delaware also requires:

Any staff who is unlicensed and providing addiction

services must be credentialed by DSAMH and/or the
credentialing board. Certified and Credentialed staff under
State regulation for SUD services include certified recovery
coaches, credentialed behavioral health technicians, RNs and
LPNs, certified alcohol and drug counselor, internationally
certified alcohol and drug counselor, certified co-occurring
disorders professional, internationally certified co-occurring
disorders professional internationally certified co-occurring
disorders professional diplomat, and licensed chemical
dependency professional (LCDP). Effective 7/1/2016,
Licensed Chemical Dependency Professionals (LCPDs) will
not be considered “unlicensed.” State regulations require
supervision of recovery coaches and credentialed
behavioral health technicians by a QHP meeting the
supervisory standards established by DSAMH. A QHP
includes the following professionals who are currently
registered with their respective Delaware board LCSWs,

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LPCMH, and LMFTs, APNs, NPs, medical doctors (MD and

DO), and psychologists. Effective 7/1/2016, LCDPs and
CADCs will be included in the definition of a QHP. The QHP
provides clinical/administrative oversight and supervision of
recovery coaches and credentialed behavioral health
technicians staff in a manner consistent with their scope of
practice.
64. The Manual reiterates:

Supervision
Behavioral Health technicians must receive clinical and
administrative supervision and oversight by a qualified
healthcare professional (QHP). A QHP includes the following
professionals who are currently registered with their
respective Delaware board LCSWs, LPCMH, LMFTs, APNs,
NPs, medical doctors (MD and DO), and psychologists.
Behavioral health technicians should have access to both
individual and group supervisions.
65. DSAMH’s Bureau of Alcoholism and Drug Abuse Rules and

Regulations’ standards applicable to all alcohol and drug service providers

require:

Drug and/or alcohol programs shall have all counselors

certified by the Delaware Alcohol and Drug Counselor
Certification Board, Inc. or the State Merit System, as meeting
the minimum standards to practice in the field. Counselors
having certification from other states must also have their
certification approved by the D.A.D.C.C.B. in order to assure
quality service.
Staff members who are not certified and are performing any
counseling functions (e.g. interns, volunteers, etc.) shall
receive documented clinical supervision from a certified
counselor.

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66. Federal Medicare and Delaware Medicaid reimburse, inter alia,

physicians and LCSWs at a higher rate than they reimburse many other

providers. Medicare does not permit LCSWs to bill for services “incident to”

their own professional services. Stated differently, even if a LCSW supervises

an employee, that employee may not bill Medicare under the LCSW’s NPI.

In addition, Delaware Medicaid does not permit unlicensed and unsupervised

providers to bill for their services at all. Thus, Connections has an incentive

to submit claims using physicians’ and LCSWs’ NPIs for work performed by

unlicensed and unsupervised providers that would otherwise be unreimbursed.

67. When the State and/or a federal or State-funded insurance

program audits Connections’ records, they conduct two separate audits: one

audit of the particular clinic’s clinical records, and another audit of the claims

for reimbursement for services provided to Medicare and Medicaid recipients

submitted by each clinic. Ms. Spruill has witnessed such audits taking place.

Based on her observation, these two audits are never conducted

simultaneously or in coordination with one another such that clinical and

financial or billing records would be compared against one another. If

Connections’ clinical records were audited at the same time as, and in

coordination with, the clinics’ claims for reimbursement for services provided

to Medicare and Medicaid recipients, then the auditors would see that the

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providers providing the services (and entering the information into EHR) are

not the same providers who are listed as the rendering providers on the claims

submitted for payment. This practice goes undetected because this additional

step is not customarily taken in auditing procedures. However, the necessary

data to conduct such a comparison is available in Connections’ electronic

files.

68. Specific, claim-level violations of the FCA and the DFCRA may

be identified with precision by comparing a Connections clinic’s claims for

reimbursement for Medicare and Medicaid services on a specific date to that

clinic’s corresponding clinical records.

69. Specifically, with respect to clinics where Ms. Spruill never

worked or supervised any individuals working at those clinics, violations of

the FCA and the DFCRA can be identified by comparing the claims for

reimbursement submitted to Medicare or Medicaid for reimbursement by or

on behalf of these clinics reflecting Ms. Spruill’s NPI with the corresponding

clinical records showing the actual employee who provided the services and

entered the information into EHR. This analysis will show neither Ms. Spruill

nor anyone she supervised provided these services. Such claims are false.

70. Similarly, with respect to clinics where Ms. Spruill worked or

supervised individuals working at these clinics during discrete periods of time,

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violations of the FCA and the DFCRA can be identified by comparing claims

for reimbursement submitted to Medicare and Medicaid by or on behalf of

these clinics reflecting Ms. Spruill’s NPI during the periods when Ms. Spruill

neither worked nor supervised anyone at these clinics with the corresponding

clinical records showing the actual employee who provided the services and

entered the information into EHR. This analysis will show neither Ms. Spruill

nor anyone she supervised provided these services. Such claims are false.

B. Malika Spruill.

71. Ms. Spruill has been a LCSW since 2010.

72. A LCSW who furnishes, bills, or receives payment for health

care in the normal course of business, and sends covered transactions

electronically, must obtain an NPI. An NPI is a unique 10-digit numeric

identifier for covered health care providers, created to improve the efficiency

and effectiveness of electronic transmission of health information. LCSWs,

as covered health care providers, must use NPIs in their administrative and

financial transactions.

73. Ms. Spruill’s NPI is 1811205909.

74. On or about August 26, 2013, Connections hired Ms. Spruill as

a LCSW in its Newark Clinic. When Ms. Spruill was hired, she was the only

LCSW at the Newark clinic. From August 26, 2013 until October 6, 2014,

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while Ms. Spruill was in the Newark Clinic, she was a Therapist. She was not

a supervisor.

75. Prior to Connections hiring Ms. Spruill, the staff at the Newark

Clinic was instructed to select Katherine Clendening (“Clendening”), a

LCSW who worked as a therapist in the Millsboro clinic, as the “bill to”

person in EHR for work performed at the Newark clinic. Clendening never

served as a clinical supervisor at any Connections clinic, let alone the Newark

clinic.

76. After Connections hired Ms. Spruill, the staff at the Newark

Clinic was instructed – without Ms. Spruill’s knowledge or permission – to

select Ms. Spruill’s name as the “bill to” person from the drop-down menu for

services provided in the Newark Clinic. Therefore, services performed by

non-credentialed, unlicensed, and unsupervised providers in the Newark

clinic were billed to Medicare and/or Medicaid as if Ms. Spruill provided

them, when she neither provided nor supervised these services.

77. By selecting Clendening, and later Ms. Spruill, as the “bill to”

person when neither Clendening nor Ms. Spruill provided these services or

supervised the provision of these services, Connections caused to be

submitted, and submitted, claims for covered services to federal and State-

funded insurance programs falsely indicating a LCSW provided these services

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(or supervised the provision of these services). Connections was reimbursed,

and continues to be reimbursed, for such services as if a LCSW provided or

supervised them. In reality, however, non-credentialed, unlicensed, and

unsupervised providers who are not entitled to any reimbursement from

Medicare and Medicaid provided these services.

78. In 2014, a co-worker informed Ms. Spruill that other counselors

were using Ms. Spruill as the “bill to” person, although Ms. Spruill was not a

supervisor. Upon learning this, Ms. Spruill emailed Ms. Vinny Hickman

(“Hickman”), the Director of Human Resources and Assistant to General

Counsel at Connections, to find out why counselors she was not supervising

were using her as the “bill to” person when she was not a supervisor and not

supervising them.

79. On or about September 12, 2014, Ms. Spruill emailed Hickman

in Connections’ Human Resources department, to find out whether persons at

Connections were using her NPI when submitting claims for reimbursement

to the Government and/or the State of Delaware.

80. On or about October 3, 2014, approximately three weeks after

emailing Hickman inquiring if someone was billing under her NPI,

Connections terminated Ms. Spruill without responding to her concerns

regarding Connections’ “bill to” practice.

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81. In or about August 2015, Ms. Spruill was re-hired by

Connections as a Clinical Supervisor.

82. According to Connections’ written materials, a Clinical

Supervisor “is responsible for providing clinical direction to an assigned

group of programs that offer short to intermediate term integrated medical,

mental health and alcohol and other drug treatment services (including MAT

and DUI treatment) in community-based treatment centers located throughout

Delaware.” A Clinical Supervisor’s principal duties and responsibilities

include “supervis[ing] all clinical activities of assigned counselors,”

“provid[ing] supervision to clinical staff, interns and others regarding cases

which are ‘billed under’ his/her license.”2

83. In her capacity as Clinical Supervisor, for approximately three

months (August 2015 to November 2015), Ms. Spruill rotated between the

Wilmington, Dover and Smyrna Clinics. During these three months, services

performed by non-credentialed providers in the Wilmington, Dover and

Smyrna clinics were billed to Medicaid using Ms. Spruill’s NPI because Ms.

Spruill was supervising these staff members.

2
Ex. 2 (Connections CSP, Inc. Job Description Clinical Supervisor in
the Integrated Outpatient Services Department).

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84. In or about August 2015 until approximately November 2015,

Connections only had three LCSWs for all of its clinics: Schneck in the

Newark Clinic, Clendening in the Millsboro Clinic, and Ms. Spruill, who split

her time between the Wilmington, Dover and Smyrna Clinics for

approximately three months until she was moved to the Dover clinic. During

this time, Frank Everette (“Everette”), a LPCMH who worked in the Dover

clinic as a therapist, and was the only other licensed person in that clinic (other

than Ms. Spruill) was used as the “bill to” person in Dover, and his NPI was

also used on group notes. Everette did not provide the services to the clients,

and he was not a supervisor. Ms. Spruill’s suggestion that Everette become a

supervisor was rejected. Therefore, during the August 2015 through

November 2015 timeframe, services performed by non-credentialed and

unsupervised providers in Connections’ clinics not supervised by Ms. Spruill,

Schneck, Clendening and/or Everette were billed to Medicare and/or

Medicaid as if Ms. Spruill, Schneck, Clendening and/or Everette provided

them and/or supervised these services when they did not.

85. Connections’ medical records show that non-credentialed and

unsupervised providers in Connections’ clinics billed to Medicare and

Medicaid as if Ms. Spruill, Schneck, Clendening and Everette provided these

services and/or supervised the services.

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86. In or about August 2015, the Wilmington clinic was run by Lisa

Shafer (“Shafer”), a LPCMH. No LCSWs worked in the Wilmington clinic

at this time.

87. Connections was not – and is not – entitled to reimbursement by

Medicare for clients seen by non-LCSW providers. Ms. Spruill did not

provide services to any of Connections’ Medicare clients receiving MAT

services. Thus, Connections was not entitled to reimbursement from

Medicare for any claims submitted for services performed, inter alia, in the

Harrington clinic, or in the Wilmington clinic while Ms. Spruill was

supervising Schafer, a LCPMH, Teresa Sharpe (“Sharpe”), a MSW and

another MSW.

88. Eventually, Kyle Vansant (“Vansant”), a LCSW, was hired as a

therapist – but not as a clinical supervisor – of the Wilmington clinic.

89. In or about August or September 2017, Connections hired

Lakeeya Thornton (“Thornton”), a LCSW, as the clinical supervisor, and

Jamy Rivera (“Rivera”), a LCSW, as the Director of the Wilmington clinic.

90. Beginning in approximately November 2015 through August 10,

2017, Ms. Spruill was moved to the Dover clinic, where she continued in her

role as Clinical Supervisor.

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91. In or about November 2016, Ms. Spruill was no longer

supervising the Smyrna clinic after Rick Thomas (“Thomas”) was hired.

Discovery is required to show exactly when employees at the Smyrna clinic

stopped using Ms. Spruill’s NPI as the “bill to” person in the Dover clinic, as

Ms. Spruill cannot independently confirm when this occurred.

92. In February 2016, Caroline Showell (“Showell”), a LCSW, was

hired as a clinical supervisor for the Millsboro clinic. Showell became the

“bill to” person for the Millsboro clinic, and Connections’ satellite site,

Longneck Outpatient.

93. When Deborah Pringle (“Pringle”) was promoted from Director

of the Millsboro clinic to Connections’ Director of Nursing, Showell was

promoted from clinical supervisor Director of the Millsboro clinic.

94. In or about July 2017, Showell left Connections.

95. For approximately two months prior to Showell’s replacement

being hired, Ms. Spruill assisted at the Millsboro clinic.

96. After Showell’s departure, Cropper, the then-Director of the

Dover clinic became the interim Director of the Millsboro clinic. Cropper had

a Bachelor’s degree, and was a CADC. In or about August or September

2017, Cropper became the Director of the Millsboro clinic, and Ms. Spruill

was promoted to Director of the Dover clinic.

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97. Following the two-month period when Ms. Spruill assisted in the

Millsboro clinic, and after Cropper took over, Connections’ employees and

agents were instructed to use Ms. Spruill as the “bill to” person for the

Millsboro Clinic, despite Ms. Spruill not working at, or supervising the

provision of services in the Millsboro Clinic during this time. Thus, services

performed by non-credentialed, unlicensed, and unsupervised providers in the

Millsboro clinic were billed to Medicare and/or Medicaid as if Ms. Spruill

provided them, when she neither provided nor supervised these services.

98. To be clear, Ms. Spruill has never seen clients at the Millsboro

clinic, and only supervised individuals at the Millsboro clinic for a two-month

period prior to Showell’s replacement being hired.

99. Thus, from approximately November 2015 through August or

September 2017, services performed by non-credentialed and unsupervised

providers in the Wilmington clinic were billed to Medicare and/or Medicaid

as if Ms. Spruill provided them or supervised these services when she did not.

100. From approximately November 2015 through February 2016,

and from in or about July 2017 to in or about August-September 2017,

services performed by non-credentialed and unsupervised providers in the

Millsboro clinic were billed to Medicare and/or Medicaid.

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101. When Ms. Spruill saw the Health Options’ Statement of Provider

Claims for the Harrington Clinic, she learned Lashonda (Johnson) Crawford

(“Crawford”), an unlicensed counselor, was using Ms. Spruill’s NPI when she

was working at Connections’ Harrington clinic. When Crawford used Ms.

Spruill’s NPI, Ms. Spruill was not supervising Crawford, nor did Ms. Spruill

have any role in providing the services billed under her NPI by Crawford.

Crawford’s use of Ms. Spruill’s NPI violated the requirement that a licensed

practitioner be on site and supervising unlicensed staff.

102. Effective August 11, 2017, Ms. Spruill’s title changed to

“Clinical Supervisor/Regional Director of Kent & Sussex County.”3

According to Connections’ written materials, a “Clinical Supervisor” “will

manage a program site and will deliver direct services to individuals with

substance use disorders or co-occurring substance abuse and mental health

conditions. This person will manage the internal relationships needed to make

the program run effectively.” The principal duties and responsibilities of the

Clinical Supervisor include, inter alia, “[p]rovid[ing] clinical supervision to

ensure[] that all treatment plan reviews are conducted in accordance with

regulatory requirements;” “[m]eet[ing] at least twice weekly with Counselor 2

3
Ex. 3 (Amended Offer Letter); Ex. 4 (Employee Action Form).

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positions for clinical supervision;” “complet[ing] document review, co-

sign[ing] documents, provid[ing] assessment and feedback of counselor 2’s

performance,” “[p]rovid[ing] clinical supervision to assure that assessments

and treatment plans are completed on a timely basis,” and “perform[] other

duties as requested or assigned, verbally or in writing.”4

103. Ms. Spruill was only briefly a regional director before her title

was changed again to clinical supervisor.

104. Effective January 18, 2018, Ms. Spruill’s title changed to “Site

Manager of the Dover AOD Program.”5

105. In April or May 2018, Ms. Spruill asked her supervisor Pringle,

then the director of Connections’ southern Delaware region, which included

the Dover, Millsboro and Seaford clinics, if she was aware of who, if anyone,

at Connections was choosing her as the “bill to” person within EHR, thus

causing Ms. Spruill to be listed as the rendering provider on the claims

submitted for payment to the Government and/or Delaware. Ms. Spruill also

asked Pringle who the new “bill to” person was going to be after Showell’s

4
Ex. 5 (Connections CSP, Inc. Job Description “Clinical
Supervisor/Site Manager – AOD Services, Program Operations.
5
Ex. 6 (Amended Offer Letter).

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then-recent departure from the Millsboro Clinic. In response, Pringle told Ms.

Spruill that Connections was using a LPCMH as the “bill to person.”

106. In May 2018, without explanation, Pringle informed Ms. Spruill

she was hiring two additional LCSWs.

107. In or about May 2018, Ms. Spruill called Health Options to ask

about the use of her NPI by individuals other than herself. Health Options

refused to provide Ms. Spruill with any information regarding the use of her

NPI by others.

108. In April or May 2018, Relator Douglas Spruill (“Mr. Spruill”),

Ms. Spruill’s husband – who was the Site Director at the Harrington clinic

until June 10, 2019 (as discussed in more detail below) – received several re-

submitted claims directly from Health Options. Mr. Spruill noticed that Ms.

Spruill’s NPI was listed as the “Rendering Provider” on these claims for

services provided at the Harrington clinic. Thus, any claims submitted to

Medicaid and Medicare were submitted under Ms. Spruill’s NPI.

109. Ms. Spruill has never seen clients at the Harrington clinic, did

not provide the services reflected on these claims for services, and never

supervised anyone providing services to clients at the Harrington clinic. Yet,

Ms. Spruill is the only designated “bill to” person for all services provided at

the Harrington clinic.

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110. On or about June 1, 2018, McKay requested a meeting with Ms.

Spruill and Connections’ Human Resources department.

111. On or about June 4, 2018, Ms. Spruill’s physician recommended

she take the remainder of the week off because her blood pressure was

extremely high. Ms. Spruill worked a full day on June 5, 2018 to complete

the previously scheduled appointments on her calendar. She began medical

leave on June 6, 2018.

112. On or about June 7, 2018, McKay requested a meeting with Ms.

Spruill without providing her any information about the purpose of the

meeting. Despite being out sick, Ms. Spruill met McKay in Wilmington,

Delaware. At this meeting, McKay and Pringle, Steven Davis and Deb

Crosson initially told Ms. Spruill she was being demoted to a therapist

position in Wilmington. Ms. Spruill was not comfortable in that position.

Later, McKay offered Ms. Spruill the Clinical Supervisor position where she

provided “clinical chart supervision” over Connections’ employees from a

remote Middletown location.

113. Prior to the June 7 meeting, McKay became aggressive and

hostile towards Ms. Spruill. For example, McKay was very short-tempered

with Ms. Spruill in meetings, and at times, would not speak to her. McKay

also claimed Ms. Spruill was consistently angry, which Ms. Spruill disputes.

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114. On or about June 8, 2018, Hicks emailed Julie Morris (“Morris”),

Mr. Spruill and Pringle stating that individuals should bill under the

supervisor from their clinic.

115. On June 11, 2018, Ms. Spruill sent Crosson her doctor’s note

extending her medical leave. On June 13, 2018, while Ms. Spruill was still

on leave, Ms. Crosson asked Ms. Spruill if she had decided to take the LCSW

position in Wilmington. On the same day, Ms. Spruill emailed Chris

Devaney, expressing her frustration over “being forced into a position” and

“being demoted to a therapist; [n]ot even a clinical supervisor” despite never

being written up.

116. Ms. Spruill’s NPI has been used in claims for services provided

at multiple Connections’ clinics at which she has never worked nor supervised

providers at these sites, including at a minimum, the Harrington clinic.

Specifically, and by way of example only, Ms. Spruill was listed as the “bill

to” person on the following Health Options’ Statement of Provider Claims for

the Harrington Clinic:

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Claim # Dates of Rendering Sub Prod Charge Clm Clm

Service Provider ID Svc/Mod Adj Payment
Amt

20581288513 09/27/17- 1811205909 90853 $40.00 $40.00 $0.00

09/27/17

20581288514 09/27/17- 1811205909 90853 $40.00 $40.00 $0.00

09/27/17

20581288516 09/27/17- 1811205909 90853 $40.00 $40.00 $0.00

09/27/17

20581288524 10/25/17- 1811205909 90853 $40.00 $40.00 $0.00

10/25/17

20581288525 10/25/17- 1811205909 90853 $40.00 $40.00 $0.00

10/25/17

20581288527 10/25/17- 1811205909 90853 $40.00 $40.00 $0.00

10/25/17

20581288530 10/27/17- 1811205909 90853 $40.00 $40.00 $0.00

10/27/17

20581288531 10/27/17- 1811205909 90853 $40.00 $40.00 $0.00

10/27/17

20681727250 12/01/17- 1811205909 90834 $95.00 $95.00 $0.00

12/01/17

20581287912 11/03/17- 1811205909 90853 $40.00 $40.00 $0.00

11/03/17

20581288056 11/10/17- 1811205909 90832 $78.00 $78.00 $0.00

11/10/17

20581288058 11/13/17- 1811205909 90834 $95.00 $95.00 $0.00

11/13/17

20581288631 11/30/17- 1811205909 90832 $78.00 $78.00 $0.00

11/30/17

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20581288704 12/05/17- 1811205909 90834 $95.00 $95.00 $0.00

12/05/17

20581288978 12/13/17- 1811205909 90834 $95.00 $95.00 $0.00

12/13/17

20781469173 11/01/17- 1811205909 H0015 $115.00 $115.00 $0.00

11/01/17 HQ

20781469174 11/01/17- 1811205909 90853 $40.00 $40.00 $0.00

11/01/17

20781469205 11/03/17- 1811205909 90853 $40.00 $40.00 $0.00

11/03/17

20781469206 11/03/17- 1811205909 90853 $40.00 $40.00 $0.00

11/03/17

20781469260 11/06/17- 1811205909 90853 $40.00 $40.00 $0.00

11/06/17

20581287923 11/02/17- 1811205909 90853 $40.00 $40.00 $0.00

11/02/17

117. Ms. Spruill has documentary evidence of approximately 651

examples of her NPI being used improperly at the Harrington clinic on Health

Options’ February 2, 2018 Statement of Provider Claims Paid for the

Harrington clinic.

118. Ms. Spruill’s NPI has been used in claims for services provided

at multiple Connections’ locations at which she has worked previously, but

she was not working at (or supervising individuals working at) these locations

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when the claims using her NPI were submitted for payment, including at a

minimum, at the Smyrna, Millsboro and Wilmington Clinics.

119. Through her conversations with Connections employees,

including but not limited to Cropper, Walker, Lezley Sexton (“Sexton”),

Heather Emerick (“Emerick”) and Hicks, Ms. Spruill learned counselors and

other lower-credentialed (or non-credentialed) providers who she was not

supervising were instructed to select her name as the “bill to” person in EHR.

120. Effective July 26, 2018, Ms. Spruill’s title changed to “Clinical

Supervisor of the Dover AOD Program.”6

121. On or about July 30, 2018, Ms. Spruill returned from medical

leave to her demoted position in the Middletown facility.

122. As of August 2018, Connections had approximately eleven (11)

LCSWs working in its Outpatient Clinics: Schneck; Erin Cliffe (“Cliffe”); and

Robert Riddler (“Riddler”) in its Newark clinic; Thomas in its Smyrna clinic;

Rivera and Thornton in its Wilmington clinic; Julie Morris (“Morris”), who

started in or about September 2017 part-time in its Harrington clinic, two

LCSWs in its Millsboro clinic, including Gail Quennville, and Ms. Spruill and

Lisa Clark (“Clark”), also a LCSW in its Dover clinic.

6
Ex. 7 (Amended Offer Letter).

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123. In November 2018, less than seven months after Ms. Spruill

asking her supervisor who was using her NPI, and Ms. Spruill calling Health

Options to get the same information, and less than five months after

Defendants demoted Ms. Spruill for such inquiries, Defendants took the

ultimate act of retaliation, and terminated Ms. Spruill.

C. Dr. Akinlawon Olugbenga Ayeni.

124. Dr. Ayeni, an Addiction Medicine specialist, is an employee or

agent of Connections, who practices telemedicine. His NPI is 1821167149.

125. CMS requires, as a condition of payment, physicians providing

telemedicine “to use an interactive audio and video telecommunications

system that permits real-time communication between you, at the distant site,

and the beneficiary, at the originating site.”7

126. Connections has used Dr. Ayeni’s NPI on thousands (the exact

number to be determined in discovery) of claims related to services provided

to clients in its Women’s Residential Program, and other clinics, for which he

did not interact with the clients, nor supervise the unlicensed providers who

7
CMS Medicare Learning Network Booklet re: Telehealth Services
at 4 (ICN 901705, Feb. 2018), available at https://www.cms.gov/Outreach-
and-Education/Medicare-Learning-Network-
MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf.

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interacted with the clients, including services for which Connections billed

federal and/or state-funded insurance programs as if he provided or supervised

such services. Specifically, and by way of example only, Dr. Ayeni was listed

as the “bill to” person on the following Health Options’ Statement of Provider

Claims for the Harrington Clinic:

Claim # Dates of Rendering Sub Prod Charge Clm Clm

Service Provider ID Svc/Mod Adj Payment
Amt
20091790466 12/13/17- 1821167149 H0048 $25.00 $25.00 $0.00
12/13/17 HF
20881565803 11/09/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/09/17
20881565808 11/10/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/10/17
20881565818 11/11/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/11/17
20881565830 11/12/17- 1821167149 H0020 $15.00 $11.00 $0400
11/12/17
20881565860 11/14/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/14/17
20881565904 11/17/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/17/17
20881565917 11/18/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/18-17
20881566119 10/22/17- 1821167149 H0020 $15.00 $11.00 $4.00
10/22/17
20881566120 10/23/17- 1821167149 H0020 $15.00 $11.00 $4.00
10/23/17
20881566124 10/26/17- 1821167149 H0020 $15.00 $11.00 $0.00
10/26/17
20881566126 10/28/17- 1821167149 H0020 $15.00 $11.00 $4.00
10/28/17
20881566131 11/20/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/20/17

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Claim # Dates of Rendering Sub Prod Charge Clm Clm

Service Provider ID Svc/Mod Adj Payment
Amt
208811566241 11/21/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/21/17
20881566247 11/22/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/22/17
20881566266 11/24/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/24/17
20881566297 11/26/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/26-17
20881566319 11/27/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/27/17
20881566354 11/30/17- 1821167149 H0048 $25.00 $25.00 $0.00
11/30/17
20881565686 11/01/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/01/17
20881565717 11/03/17- 1821167149 H0020 $15.00 $11.00 $4.00
11/03/17

127. In addition, and by way of example only, Ms. Spruill has

documentary evidence of approximately 971 examples of Dr. Ayeni’s NPI

being used as the “bill to” person on Health Options’ February 2, 2018

Statement of Provider Claims Paid for the Harrington clinic.

128. Dr. Ayeni neither directed nor inspected the work, actions, or

performance of, nor oversaw the work of the Connections’ employees and/or

agents who used his NPI, as described herein.

D. Fabrication of Medical Records.

129. On or about November 11, 2015, Diveadra Harmon (“Harmon”),

EHR Support and Clinical Technician at Connections, informed Hicks that

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Dr. Ayeni, Dr. Adaeze Udezue (“Dr. Udezue”) and Dr. Scott Houser (“Dr.

Houser”) had missing and unsigned documents in the EHR.

130. Specifically, as of the review on November 9, 2015, Dr. Ayeni

had fifty (50) unsigned documents related to MAT clients from the Newark

and Dover clinics, twenty-nine (29) unsigned documents related to

methadone/buprenorphine clients from the Newark clinic, and fifteen (15)

other unsigned notes related to, inter alia, admissions for buprenorphine,

admissions for methadone, biopsychosocial assessment, and MAT CPE from

the Newark and Dover clinics for clients he had seen as far back as February

2015.

131. As of November 9, 2015, Dr. Udezue, a substance abuse/MAT

doctor at Connections, had, inter alia, not signed nine evaluation for

methadone/buprenorphine notes, two progress notes, eight physician progress

notes, two medical physician progress notes, one MAT CPE, two admission

notes for methadone and four admission notes for buprenorphine for clients

she had seen as far back as September 2, 2015 in the Millsboro clinic.

132. As of November 9, 2015, Dr. Houser, a psychiatrist at

Connections, had, inter alia, twenty-four (24) MAT service documents

missing for patents he had seen as far back as March 23, 2015; twenty-four

(24) missing Methadone/suboxone evaluations that CareLogic did not locate

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for patents he had seen as far back as November 21, 2014; fifty-two (52)

physician progress notes missing for patients he had seen as far back as March

24, 2015; and fifteen (15) missing medical physician progress notes for

patients he had seen as far back as November 10, 2014 at the Newark clinic.

133. In 2017, Dr. Ayeni had over 500 unfinished medical records in

the CareLogic software program.

134. Mr. Spruill noticed Dr. Ayeni’s records were incomplete.

Thereafter, Mr. Spruill noticed these records had been completed.

135. Dr. Ayeni did not complete these records himself. Instead,

Pringle, who had administrative access to CareLogic (prior to her termination

from Connections on or about June 7, 2018), completed these records on Dr.

Ayeni’s behalf.

136. Pringle did not consult with Dr. Ayeni to obtain the facts relevant

to the clients’ care, nor did she have any notes relevant to these clients’ care

on the dates of service in question. Instead, Pringle fabricated Dr. Ayeni’s

incomplete records to make it look like they were complete and services were

provided by Dr. Ayeni.

137. The records Pringle fabricated inaccurately describe the services

provided and the clients’ conditions.

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138. Karen Hanson Saroglia (“Saroglia”) was also required to login to

CareLogic using Dr. Ayeni’s login credentials and fabricate over 1,400 of Dr.

Ayeni’s unfinished records.

139. Saroglia did not consult with Dr. Ayeni to obtain the facts

relevant to the clients’ care, nor did she have any notes relevant to these

clients’ care on the dates of service in question. Instead, Saroglia fabricated

Dr. Ayeni’s incomplete records to make it look like they were complete and

services were provided by Dr. Ayeni.

140. Dr. Somasunderman Padmalinggam (“Dr. Padmalinggam”) is a

family practitioner, who worked at several of Connections’ clinics, including

the Smyrna, Dover and Harrington clinics.

141. On or about August 30, 2017, Dr. Padmalinggam was terminated

from Connections and escorted from the building.

142. When he was terminated, Dr. Padmalinggam had not completed

his records in CareLogic.

143. Approximately two weeks after Dr. Padmalinggam was

terminated, Ms. Spruill noticed Dr. Padmalinggam records had been

completed.

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144. Dr. Padmalinggam could not have completed these records

himself because these records were incomplete when he was terminated from

Connections and escorted from the building.

145. Doctors working at Connections were not the only Connections’

personnel whose records were falsified, or who failed to complete the required

paperwork.

146. As Ms. Spruill explained on or around October 26, 2015:

Did you speak with [redacted] on Friday and do you feel that
he understood what was expected from him? I’m asking
because he submitted several recovery plans and although I
said I would not un sign them, some of them I have to. He has
a recovery plan that was due in August that he just did in
today, however he left gaps in treatment. I’m trying to
allow him to complete work, but I will not sign work that is
completely wrong and could cause issues with an audit. 
(emphasis added).
147. Connections recordkeeping is so horrendous that, in at least one

instance, one client’s information was scanned into another client’s chart

causing Schneck to flag the second client’s chart as missing a transfer

summary.

148. In another example, on or around August 30, 2018, Cliffe asked

Ms. Spruill to sign off on a record in which Cliffe wrote “Treat for Diabetes

and Spinal Fusion” when the underlying record clearly stated “refer to a

specialist.” As Ms. Spruill told Cliffe before sending the record back to Cliffe:

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I am very sorry, but I am no longer going to be able to sign

things that I can’t clinically stand by. When I sign my name,
it is saying that I agree with what is written and in some
instances, that is not correct. I am sending back RB (11068).
I believe we can monitor her medical condition without
actually stating that we are going to treat it. If we were
treating her Diabetes, than yes. A spinal fusion, I am not
sure about that and how we can go about treating that. The
fact that she states that we are referring to a specialist and
then says Treat is very contradicting. However, if you are
comfortable with it, then I think you should be the one who
signs it. (emphasis added).
149. Following her exchange with Cliffe, Ms. Spruill told Baker:

I am not comfortable signing some of the stuff that they say. I

am not signing something that Erin [Cliffe] says Treat for
Diabetes and Spinal Fusion when it clearly states that it says
refer to a specialist.
150. On or about May 8, 2017, McKay was informed her employees

were, inter alia, being asked to “fraudulently sign[] documents and/or add[]

unknown milligrams of medications on documents,” and “violat[ing]

HIPPA.”

151. While Connections routinely fabricated medical records, during

the period leading up to external audits, Connections rushed to complete its

documentation regardless of whether the final documents had any relation to

the actual services or treatment provided. By way of example only, on or

about January 23, 2013, Chris Devaney, Connections’ Chief Operating

Officer, flagged several documentation issues noting: “This is not

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good…either documentation is not complete or people aren’t working. This

needs to improve by the end of the week.”

152. More than a year later, on or about June 2, 2014, the

documentation problem persisted at Connections. As Anna Harmon

explained to the ACT1 Newark team:

153. Connections knew its shoddy recordkeeping was “a violation of

HIPPA” and it would be in “MAJOR trouble” if the State did “a pop up audit”

and saw these charts “scattered across the floors and around the desks” and

“under desks, on the floor, in drawers, etc.” As Chanda Gibson (“Gibson”),

the Performance Improvement Coordinator for the ACT Teams warned:

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154. Not only did Connections’ records fail to comply with the

applicable regulations, but its personnel lacked the required training and

certifications required to comply with DSAMH’s requirements and other

applicable regulations.

155. In February 2016, in advance of Dover’s DSAMH outpatient

audit, McKay was “worried about Smyrna and Dover where there [was] no

site manager.” Thus, McKay scheduled time to talk with Ms. Spruill, Cropper

and Heather Emrick (“Emrick”) about the impending audits.

156. On or about April 15, 2016, with the Smyrna clinic’s audit fast

approaching, McKay decided to “make chart auditing for them a priority” and

wanted to “talk about … what we can do to make sure that their audit is as

good as it can be?”

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157. In advance of the audits on the files for Clint Walker, Blackbird

Landing, Gordy Place, West Street Commons, Connections emailed a “list of

individuals that are in need of various documents.…” and urged the recipients

to send the documents promptly.

158. On or about August 18, 2018, after having looked again at the

status of the clinical supervision in Dover, McKay was “really worried that

there [were] hundreds of unsigned documents. … The ones that worry me

the most are the recovery plans, which are clearly out of compliance.”

(emphasis added).

159. On or about February 7, 2017, McKay recognized “[a]ll of a

sudden, DSAMH is coming fast and furious to audit” and called on her staff

to “make it a priority to get ready.”

160. By April 17, 2017, McKay began to panic about the audit of the

Dover clinic, and directed her staff to blindly sign unsigned documents.

Specifically, she told Cropper and Ms. Spruill:

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161. In 2018, the Dover clinic’s records were no better than they were

the year prior forcing Ms. Spruill to email the Dover AOD team:

162. Prior to the 2018 audit, the Harrington clinic’s documents

continued to be in a state of disarray. When Anthony Davis selected fifteen

of his most compliant files for the audit, two of them were “not a good choice

for an active or discharge client,” one because his “Front Desk Consents were

not completed at the time of intake on 5.18.18, but 27 days later on 6.13.18”

and the other because his Front Desk Intakes “were not completed at the time

of intake on 6.14.19 but 29 days later on 7.12.18.”

163. In August 2018, Connections was still “trying to get ready for

CARF and DSAMH” and had “a lot of med checks that [were] past due.”

164. On or about October 2, 2018, Mr. Spruill notified Chris DeVaney

and Lamont Baker that the Harrington clinic did not have a full-time nurse

practitioner and would be out of compliance. Mr. Spruill also told Chris

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DeVaney and Baker that the Harrington clinic was “not in compliance for the

fast track 23s CPEs, MH appts and IOP sick calls.”

165. On or about April 12, 2019, Glenn LeFevre, a Senior SUD

Treatment Administrator, sent Mr. Spruill an updated job description for the

“Site Manager” position and an updated agreement that added substantial

additional responsibilities to his position, in addition to his current

responsibilities, and drastically modified his schedule. As Mr. Spruill

explained in his April 15, 2019 response, Connections was retaliating against

him for revealing its “fraudulent billing practices” and that the “levels of care

at HWMC” failed to meet the standards for regulatory compliance, and these

documents were “punitive” and “without justification.”

166. As of June 10, 2019 when Connections improperly terminated

Mr. Spruill, the Harrington clinic still failed to comply with the requirements

for the “fast track” program’s CPE’s, mental health appointments and IOP

sick calls.

E. Medically Unnecessary Intake Sessions.

167. The Manual provides for Connections to be reimbursed at

predetermined rates for providing specific, medically-necessary alcohol and

drug treatment services.

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168. All of Connections’ new clients are required to participate in an

intake session. During the intake session, Connections determines the level

of services that each client should receive.

169. All Connections facilities conduct intake sessions, however, only

the Harrington clinic offers intake services twenty-four hours a day, seven

days a week.

170. Harrington is also the only clinic that offers up to twenty-three

hours of continuous observation, monitoring, and support in a supervised

environment for individuals initially recovering from the effects of alcohol

and/or other drugs, i.e. the “23-hour program.”

171. After clients who are receiving medication-assisted therapy

(“MAT”) services for opioid addiction miss three consecutive days of dosing,

they are required to speak with a physician. Rather than allowing clients to

speak with an on-call physician, Connections requires clients to submit to

another intake. If the client presents to a clinic that is not offering an intake

session that day, Connections arranges for the client to be transported to the

Harrington clinic. Once at the Harrington clinic, the client is subjected to

another intake and admitted into the 23-hour program. Connections refers to

this as its “fast track” program.

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172. Connections “fast tracks” clients every day at its Harrington

clinic. Its policy is to “fast track” as many clients as possible, regardless of

the client’s medical needs, so Connections can receive the per diem

reimbursement rate of $334.27 (Code H0012) for each client.

173. Connections effectively treats all clients sent to the Harrington

clinic for an intake as new clients, even though they may have been actively

treating with Connections for an extended period of time, and only recently

missed three consecutive days of dosing, so it may bill Medicare, Medicaid

and/or DSAMH for a new assessment.

174. If clients refuse to participate in the additional intake,

Connections refuses to dose him/her.

175. After the “fast track” program, clients are returned to the clinic

that referred them to Harrington. Then, that clinic provides the same services

as Harrington provided in the “fast track” program.

176. Mr. Spruill has discussed the “fast track” program with Dr.

Henry Luu (“Dr. Luu”), a provider of telemedicine services at Connections.

Mr. Spruill and Dr. Luu have also discussed the procedure that should be

followed when a client misses dosing sessions, i.e. meeting with a physician

and then resuming his/her dosing program.

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177. When Connections seeks reimbursement for clients in its “fast

track” program, it is reimbursed for 23-hours of services, even if it provides

only four hours of services.

178. Connections rarely provides more than four hours of services to

its clients in the “fast track” program regardless of the client’s medical needs.

Mr. Spruill estimates that less than 25% of Connections’ “fast track” clients

receive 23-hours of services.

179. Some of the clients who received intake assessments at the

Harrington facility were referred to Connections by Christiana Care Health

Systems (“Christiana Care”). Christiana Care and Connections collaborated

together to implement a program known as Project Engage whereby

Christiana Care hospitals referred substance abuse patients to Connections.

Upon receiving referrals, Connections tracks these referrals internally as

being referred from Christiana Care.

180. Connections’ policy, as required by McKay and Baker, was that

all Project Engage referrals had to be accepted regardless of whether

Connections’ employee thought the client could be properly treated at the

clinic. By way of example, one specific Project Engage referral had a high

BAC. Connections’ Harrington staff did not want to accept the client, and in

response, McKay indicated that all referrals were to be accepted. McKay also

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required a record to be kept and reported to her daily if any clients from

Christiana Care were sent back to the hospital.

F. Manipulation of Length of Services Provided to Meet

Arbitrary Billing Targets.
181. CareLogic places a timestamp on every activity entered into the

system. As Emrick warned: “Length of client sessions- Carelogic puts time

stamps on every activity we check-in/check-out. This means if we are billing

for a 1-hour session, the client needs to be in our offices for a minimum of 45

minutes.”

182. Nevertheless, Connections billed Medicare, Medicaid and

DSAMH for the maximum time allowed for each service regardless of

whether Connections actually saw the client for that length of time.

183. Connections also began double-booking its providers for, inter

alia, mental health appointments and intakes.

184. After Shockley questioned the Dover clinic’s practice of

scheduling its clients during the Harrington clinic’s allotted appointments

with Dr. Luu, on or about August 30, 2018, Johanna Johnson explained:

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185. To hide its practice of double-booking, Connections records are

fabricated to make it look like its providers are seeing clients when, in reality,

the Connections’ employees have clocked out and left the facility.

186. By way of example only, records for a provider at the Dover

clinic have been fabricated to make it appear she had, for example, eleven

individual sessions and a group sessions between the hours of 5:00 a.m. and

4:00 p.m. without a single break one day, and eight individual sessions and a

group session on two other days between the hours of 5:00 a.m. and 3:00 p.m.,

with no appointments scheduled from 7:00 a.m. – 8:00 a.m.

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187. In reality, this team at the Dover clinic does not work twelve-

hour shifts (certainly not without breaks), and is more likely to work no later

than 1:30 p.m. each day.

188. McKay and Devaney frequently reminded Connections’

employees of their billing targets. Devaney repeatedly pressured

Connections’ employees to meet their billing targets, and demanded detailed

plans as to how they were going to meet their targets.

189. Zoe Timme (“Timme”), Director of Community Behavioral

Health Services at Connections, also pressured Connections employees to

make their targeted hours. For example, on or about February 24, 2014,

Timme told Mr. Spruill and others she was “very concerned about the number

of service hours you have entered so far this month. This is a critical element

of your job at Connections and it is inexcusable to simply neglect

documentation. These notes should be entered on a daily basis in order to

adequately document the services you provide.”

190. As of July 8, 2014, Chris Devaney gave the ACT1 team in

Newark “until the end of the day [on July 8, 2014] to add June hours.” The

team was instructed to “go back into links and [their] schedules to review

[their] June hours and add what [they] may have missed.”

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191. On or about November 1, 2017, McKay changed the billing

targets, and all counselors, site managers, LCSWs, LPCMHs, peer specialists,

CADCs, physicians and other Connections’ employees were expected to meet

these new targets, despite not picking up any additional hours, overtime being

prohibits and no influx of new patients. As a one-time incentive, staff

members who met their November 2017 billing targets, were eligible for a

$100 bonus.

192. Connections tracked its employees’ actual production to goal in

various ways, including on a monthly “Outpatient Billing Target Report.”

Ironically, the June 2018 Outpatient Billing Target Report was named “Top

Secret.xlsx.” Despite threatening “corrective actions for everyone who [was]

yellow” in May 2017, when McKay circulated the billing targets for October

2017, she voiced her disappointment: “Some of these are god awful.” By

March 2018, McKay demanded “a specific corrective action plan for each

person who [was] highlighted in yellow.”

193. Faced with this pressure and threat of termination, Connections’

employees constantly thought of creative ways to generate additional revenue.

For example, on or about October 16, 2018, Mr. Spruill proposed an idea to

Baker he thought might work to increase billing, and asked Baker to obtain

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McKay and/or Devaney’s approval before he implemented this plan for

generating more revenue for Connections.

G. Dosing Clients Before They Are Seen By A Physician and A

Licensed Provider.
194. Contrary to its policy, Connections doses clients before they are

seen by Connections’ doctors and licensed counselors. In one example, on or

about January 25, 2016, Ms. Spruill uncovered two clients who were “guest

dosing” at the Millsboro clinic before they had gone through Connections’

intake procedure or been in the clinic for thirty days. These clients were not

on the doctors’ schedule for an intake, and they were scheduled to see Dr.

Udezue. As Ms. Spruill observed, “Ridiculous! … I suppose they were just

going to keep sending him as a guest doser. There are two more like him here

now, that have also not seen the dr and are guest dosing.”

195. On or about July 19, 2017, Pringle reminded Connections’ staff:

Please make sure that when you schedule a Client for their
annual CPE they also must be scheduled with the Doctor
who is prescribing their medication, they have to see both
the NP, PA, and The Doctor that is prescribing their
medication on the same day. Please Nurses go back and
audit your MAT charts and if this have not happen make
appointments with the Doctor ASAP please if anyone have
any questions or concerns please let know. Directors can
you please add this to your chart Auditors list of medical
documentation that should be completed annually.
(emphasis in original)

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196. In another example, Connections began dosing a client on or

about March 23, 2018 and by May 24, 2018, the client still have not seen a

doctor or licensed counselor.

197. As Ms. Spruill stated in her May 24, 2018 email to Johanna

Johnson and the Dover AOD team:

This CAN’T Happen! Clients cannot be dosing with us for

2 months with us not seeing them!!!! If this person died on
our watch, we would be screwed!!! Unacceptable! They need
to be seen by a counselor within a week or they don’t get a
freakin DOSE!!!!!!! I don’t give a damn if they are MAD!!!!!!
198. During an audit on January 29, 2019, Johanna Johnson

(“Johnson”), Nurse Manager at the Dover and Harrington clinic, found a client

was referred and added to the Dover clinic’s per diem as of January 24, 2019.

However, he “never started/transferred with Dover. Last dosing with

Harrington 1/24/19.” She admonished Harrington Nurses to:

Please make sure before referring/transferring programs, that

client has showed to new clinic. This client has been getting
billed as dosing with Dover since 1/24/19 but has not. Wait
until last does is verified before changing over the programs.
(emphasis added)
H. Connections Bills DSAMH and Medicaid for the Same
Claims.

199. When an uninsured client presents at Connections for treatment,

Connections submits a claim to DSAMH for reimbursement for services

provided to that client.

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200. Upon information and belief, Hicks prepares the claim and

submits a hard copy of the claim to DSAMH.

201. Based on the information provided to DSAMH indicating that

the client is uninsured, DSAMH approves these claims and reimburses

Connections.

202. Connections also enrolls the uninsured client in Medicaid and

submits a claim to Medicaid for the services provided to the client through

CareLogic. Thus, Connections seeks reimbursement from Medicaid for the

same services it seeks and ultimately receives reimbursement from DSAMH.

203. Once the client is enrolled in Medicaid, Medicaid also

reimburses Connections for these services causing Connections to be

reimbursed twice for the same services, once by DSAMH and once by

Medicaid.

204. Connections does not return either of these payments to DSAMH

or Medicaid.

I. Connections Submits Claims to Medicare Knowing Such

Claims Will Be Rejected, and Then Submits the Claims to DSAMH.

205. Connections routinely submits claims for MAT services to

Medicare knowing such claims will be denied.

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206. After Medicare denies the claim, Connections submits the claim

to DSAMH for reimbursement, relying on DSAMH’s coverage of necessary

treatment not otherwise covered by alternative sources.

207. Although this practice results in no loss to Medicare, it

constitutes submission or presentment of false claims. In addition, this

practice wastes the scarce resources made available to those who need the

services Medicare provides.

J. Connections Unbundles Billing Codes to Fraudulently

Increase Reimbursement.
208. The Manual allows for reimbursement of IOP services, including

group and individual therapy, assessments, counseling, crisis intervention,

education, depending on the type, amount and frequency of services provided.

209. For IOP per diem claims, “the services must be delivered in

accredited programs where there is a licensed practitioner on-site and

supervising unlicensed staff and the individuals must meet admission criteria

for a higher level or care as specified in the provider manual.” Manual at 44-

45.

210. Claims for reimbursement for IOP services are submitted under

Code H0015, and require not less than nine and no more than nineteen hours

of contact per week, with a minimum of three contact days per week.

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211. Connections frequently fails to provide the minimum required

nine contact hours per week. Thus, to maximize its reimbursement and avoid

the nine-hour minimum required to bill for IOP services, Connections

unbundles these services and bills them as individual services.

212. Connections bills for these IOP services on a per unit basis rather

than a per diem basis, and submits unbundled claims that allows it to receive

a larger reimbursement than it is entitled to receive for these services.

IV. GOVERNING LAW

A. Medicare
213. In 1965, Congress enacted Title XVIII of the Social Security Act,

known as the Medicare program. Medicare is a federally-funded health

insurance program primarily benefitting the elderly. Entitlement to Medicare

is based on age, disability or affliction with end-stage renal disease.

See 42 U.S.C. § 426 et seq.

214. The Medicare program is administered through the Department

of Health and Human Services, Centers for Medicare and Medicaid Services

(“CMS”).

215. To assist in the administration of Medicare Part A, CMS

contracts with “fiscal intermediaries.” 42 U.S.C. § 1395(h). Fiscal

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intermediaries, typical insurance companies, are responsible for processing

and paying claims and auditing cost reports.

216. When providers such as Connections enroll for Medicare, they

complete the Medicare Enrollment Application, i.e. Form CMS-855B

(“Medicare Application”). Section 14 of the Medicare Application explains

the penalties for deliberately falsifying information to gain or maintain

enrollment in the Medicare program, including those under the FCA:

217. Section 15 of the Medicare Applications must be signed by an

authorized official, i.e. “an appointed official … to whom the organization has

granted the legal authority to enroll it in the Medicare program, to make

changes or updates to the organization’s status in the Medicare program, and

to commit the organization to fully abide by the statutes, regulations, and

program instructions of the Medicare program.” The Medicare Applications

suggests the authorized official should be the organization’s chief executive

officer, chief financial officer, general partner, chairman of the board or direct

owner. By signing the Medicare Application, “an authorized official binds

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the supplier to all of the requirements listed in the Certification Statement and

acknowledges that the suppler may be denied entry to or revoked from the

Medicare program if any requirements are not met.”

218. The Medicare Application requires the applicant to meet and

maintain additional requirements to bill to the Medicare program, and by

signing the Medicare Applications the applicant “is attesting to having read

the requirements and understanding them.”

219. For example, in order to bill the Medicare program, providers

agree to adhere to, inter alia, the following:

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220. The Medicare Application must be signed in ink, and if the

signature is deemed not an original, the Medicare Application will not be

processed.

221. According to the Medicare Claims Processing Manual, Medicare

pays claims submitted by clinical social workers at 75% of the Medicare

Physician Fee Schedule. The CMS currently recognizes LCSWs, and

Medicare Part B covers LCSWs.

222. Medicare does not authorize LCSWs to bill for services

furnished incident to their own professional services. In other words, persons

they supervise may not bill Medicare under a LCSW’s NPI for services

performed by that individual under the supervision of the LCSW.

223. Medicare currently considers, inter alia, LPCMHs, LMFTs and

CADCs “non-eligible” providers. Thus, LPCMHs, LMFTs and CADCs may

not contract with Medicare, submit claims to Medicare, or be reimbursed by

Medicare.

224. The Medicare Health Insurance Claim Form, i.e. Form CMS-

1500, warns:

NOTICE: Any person who knowingly files a statement of

claim containing any misrepresentation or any false,
incomplete or misleading information may be guilty of a
criminal act punishable under law and may be subject to civil
penalties. (emphasis in original).

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225. When a provider signs and submits a Form CMS-1500, the

provider certifies:

1) the information on this form is true, accurate and

complete; 2) I have familiarized myself with all applicable
laws, regulations, and program instructions, which are
available from the Medicare contractor; 3) I have provided or
will provide sufficient information required to allow the
government to make an informed eligibility and payment
decision; 4) this claim, whether submitted by me or on my
behalf by my designated billing company, complies with all
applicable Medicare and/or Medicaid laws, regulations,
and program instructions for payment including but not
limited to the Federal anti-kickback statute and Physician
Self-Referral law (commonly known as Stark law); 5) the
services on this form were medically necessary and
personally furnished by me or were furnished incident to
my professional service by my employee under my direct
supervision, except as otherwise expressly permitted by
Medicare or TRICARE; 6) for each service rendered
incident to my professional service, the identity (legal
name and NPI, license #, or SSN) of the primary individual
rendering each service is reported in the designated
section. For services to be considered "incident to" a
physician's professional services, 1) they must be rendered
under the physician's direct supervision by his/her employee,
2) they must be an integral, although incidental part of a
covered physician service, 3) they must be of kinds commonly
furnished in physician's offices, and 4) the services of non-
physicians must be included on the physician's bills.
***
No Part B Medicare benefits may be paid unless this form is
received as required by existing law and regulations (42 CFR
424.32) (emphasis added).
226. Form CMS-1500 warns providers seeking Medicare

reimbursement:

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NOTICE: Any one who misrepresents or falsifies essential

information to receive payment from Federal funds requested
by this form may upon conviction be subject to fine and
imprisonment under applicable Federal laws
227. Each provider submitting a Form CMS-1500 for Medicaid

reimbursement certifies:

I hereby agree to keep such records as are necessary to disclose

fully the extent of services provided to individuals under the
State's Title XIX plan and to furnish information regarding
any payments claimed for providing such services as the State
Agency or Dept. of Health and Human Services may request.
I further agree to accept, as payment in full, the amount paid
by the Medicaid program for those claims submitted for
payment under that program, with the exception of authorized
deductible, coinsurance, co-payment or similar cost-sharing
charge.
228. By signing the Form CMS-1500, the provider certifies:

I certify that the services listed above were medically indicated

and necessary to the health of this patient and were personally
furnished by me or my employee under my personal direction.
229. Form CMS-1500 warns providers seeking Medicaid

reimbursement:

NOTICE: This is to certify that the foregoing information is

true, accurate and complete. I understand that payment and
satisfaction of this claim will be from Federal and State funds,
and that any false claims, statements, or documents, or
concealment of a material fact, may be prosecuted under
applicable Federal or State laws.
230. “Altering claim forms, electronic claim records, medical

documentation, etc. to obtain a higher payment amount” and

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“[m]isrepresenting dates and descriptions of services furnished or the identity

of the beneficiary or the individual who furnishes the service” are two of

several examples in a non-exhaustive list of Medicare fraud examples

identified in the Medicare Program Integrity Manual.

231. CMS’s Medicare Fraud & Abuse: Prevention, Detection, and

Reporting booklet lists as one of several examples of Medicare fraud:

“Knowingly billing for services at a level of complexity higher than services

actually provided or documented in the file.”

B. Medicaid

232. Delaware’s Medicaid program “furnishes medical assistance to

eligible Delaware low-income families and to eligible aged, blind and/or

disabled people whose income is insufficient to meet the cost of necessary

medical services.” To qualify for Delaware’s Medicaid program, individuals

must be a resident of the state of Delaware, a U.S. national, citizen, permanent

resident, or legal alien, in need of health care/insurance assistance, whose

financial situation may be characterized as low income or very low income.

For example, in order to qualify, an individual with four members in her

household must have an annual household income before taxes below

$32,178. “For Adult Medicaid the individual must be between the ages of

19 and 64, and for Youth Medicaid the individual must be between the ages

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of 6 and 18. Some individuals must meet specific technical reasons such as

age, pregnancy, or disability.”

233. Delaware’s Medicaid program is administered through the

Delaware Division of Medicaid & Medical Assistance (DMMA).

234. Prior to January 2018, United Healthcare and Health Options

offered Medicaid benefits to Delaware residents. Currently, Health Options

and AmeriHeath Caritas offer Medicaid benefits to approximately 200,000 of

the current 225,000 Medicaid clients in Delaware.

235. When a provider enrolls with Medicaid in Delaware, it must

enter into a contract with the State of Delaware, the Department of Health and

Social Services, the Division of Medicaid and Medical Assistances, and the

Delaware Medical Assistance Program (“DMAP”) (the “Medicaid

Enrollment Agreement”).

236. The provider must agree to the conditions stated in the Medicaid

Enrollment Agreement. For example, by applying to participate in Delaware

Medicaid, the provider agrees any claim submitted by or on its behalf under

the DMAP:

shall constitute certification by the Provider that the items or

services for which payment is claimed wherein compliance
with the DMAP rules, regulations and policies, including but
not limited to: that the items or services were actually rendered
by the Provider to and medically necessary for the person
identified as the DMAP eligible; that the claim does not

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exceed the Provider's charge for the same or equivalent items

or services provided to persons who are not DMAP eligible;
that the claim is correctly coded in accordance with billing
instructions prescribed by the DMAP; and, that all information
submitted with or in support of the claim is true, accurate, and
complete.
The DMAP agrees to reimburse the Provider for those
allowable medical and related items or services provided to a
DMAP eligible in amounts determined solely at the discretion
of the DMAP in accordance with the Federal Medical
Assistance Program or the DMAP laws and regulations.
Reimbursement will be in accordance with policies as
established by the DMAP. The DMAP may deny
reimbursement for any cost incurred for items or services
rendered not in compliance with this Contract. Payment by the
DMAP is subject to the availability of State and/or Federal
funds.
Prior to billing the DMAP, the Provider shall be responsible
for identifying and making collection from any other third
party payer who may, by insurance contractor or otherwise, be
liable for all or part of the cost of items or services provided,
except where waived by DMAP policy. In the event that a
claim with third party liability coverage exists and has been
paid by the DMAP, the Provider shall promptly reimburse the
DMAP in accordance with the DMAP policies and
procedures.
The Provider shall not solicit, charge, accept, or receive any
money, gift or other consideration from a DMAP eligible or
from any other person on behalf of the eligible for any service
or item allowable under the DMAP, except to the extent that
the DMAP regulations require a DMAP eligible contribution
or require the Provider to bill a third party prior to billing the
DMAP.
Prior to rendering any item or service, the Provider shall
inform the DMAP eligible of any item or service which the
Provider will deliver to him or her which will not be covered
by the DMAP and for which item or service the DMAP
eligible must pay.

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The Provider shall accept the amounts paid to it by the DMAP

in accordance with the DMAP regulations as payment in full
for such items or services.8
237. By signing the Medicaid Enrollment Agreement, the provider

certifies:

I understand in endorsing or depositing checks or accepting

electronic fund transfers that payment will be from Federal
and State funds and that any falsification, or concealment of a
material fact, may be prosecuted under Federal and State law.9
238. Per the Medicaid Enrollment Agreement, the provider is required

to make timely restitution to the DMAP “for any payments received in excess

of amounts due to the Provider under the DMAP regulations or payment

schedules whether such overpayment is discovered by the Provider or by the

DMAP. The DMAP retains the right to offset reimbursements to be made to

the Provider subsequent to the identification of an overpayment.”10

239. Per the Medicaid Enrollment Agreement: “The Provider is

responsible for the proper licensure and actions of his/her employees. The

DMAP will regard any failure to comply with the DMAP’s rules, regulations

8
Ex. 8 (Delaware Health and Social Services Medicaid Enrollment
Agreement) ¶ 3.
9
Ex. 8 (Delaware Health and Social Services Medicaid Enrollment
Agreement) ¶ 3.
10
Ex. 8 (Delaware Health and Social Services Medicaid Enrollment
Agreement) ¶ 4.

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or policies or any negligent or fraudulent act by such an employee against the

DMAP as an action of the Provider.”11

240. Connections made the foregoing certifications and

representations to participate in and submit claims for reimbursement under

the Delaware Medicaid program.

241. Connections also resubmitted and recertified the accuracy of its

enrollment information on its periodic Revalidation Applications, which

allow it to continue participating in and submitting claims for reimbursement

under the Delaware Medicaid program.

C. Licensed Clinical Social Worker

242. LCSWs in Delaware are governed by 24 Del C. §§ 3901 et seq.,

and Title 24 of the Delaware Administrative Code § 3900 et seq.

243. According to the Delaware Code, a “licensed clinical social

worker” is “any individual duly licensed under [Title 24, Chapter 39 of the

Delaware Code].” 24 Del C. § 3902(6).

244. In Delaware, no person shall engage in the independent practice

of clinical social work or hold himself or herself out to the public, as being

qualified to practice clinical social work; or “use in connection with that

11
Ex. 8 (Delaware Health and Social Services Medicaid Enrollment
Agreement) ¶ 11.

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individual’s name, or otherwise assume or use, any title or description

conveying or tending to convey the impression that the individual is qualified

to practice clinical social work,” unless such person has been duly licensed

under Title 24, Chapter 39 of the Delaware Code. 24 Del C. § 3903(a).

245. Pursuant to Title 24 of the Delaware Administrative Code § 3900

¶ 9.3.3, a LCSW, or any employee or supervisee of the LCSW, “must be

accurately identified on any bill as the person providing a particular service,

and the fee charged the client should be at the [LCSW’s] usual and customary

rate.”

D. Federal False Claims Act

246. In 1863, motivated by unscrupulous government contractors

during the Civil War, Congress enacted the FCA, and it was substantially

amended in 1986 by the False Claims Amendments Act, Pub. L. 99-562, 100

Stat. 3153 to strengthen and enhance enforcement of the FCA. The 1986

Amendments increased the damages and penalties that could be recovered,

increased the incentives for private citizens to come forward and identify

fraudulent conduct, added protections for whistleblowers against retaliation,

defined knowledge specifically, declared specific intent was unnecessary,

provided for a preponderance of the evidence standard, and expanded the

statute of limitations. In 2009, the FCA was further amended by the Fraud

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Enforcement and Recovery Act of 2009, which expanded the FCA to reach

frauds by financial institutions and other recipients of TARP and other

economic stimulus funds, reduced intent required to establish liability, and

relaxed the necessary connection between the false statement and payment.

247. The FCA provides, in pertinent part, that any person who

knowingly presents, or causes to be presented, a false or fraudulent claim for

payment or approval; or knowingly makes, uses, or causes to be made or used,

a false record or statement material to a false or fraudulent claim is liable to

the Government for a civil penalty of not less than $11,181 and not more than

$22,363, as adjusted by the Federal Civil Penalties Inflation Adjustment Act

of 1990, plus three times the amount of damages which the Government

sustains because of the act of that person. 31 U.S.C. § 3729(a). The FCA

defines “knowing” and “knowingly” to mean that a person, with respect to

information, has actual knowledge of the information; acts in deliberate

ignorance of the truth or falsity of the information; or acts in reckless disregard

of the truth or falsity of the information; and no proof of specific intent to

defraud is required. 31 U.S.C. § 3729(b). A person violating the FCA shall

also be liable to the Government for the costs of a civil action brought to

receive any such penalty or damages. 31 U.S.C. § 3729(3).

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248. As alleged in more detail herein, Defendants knowingly violated

the FCA by presenting or causing to be presented false or fraudulent claims

for payment to federally-funded insurance programs for payment or approval

and/or knowingly making, using or causing to be made or used false records

or statements material to false or fraudulent claims to federally-funded

insurance programs related to services provided by unlicensed and

unsupervised Connections’ employees or agents using Ms. Spruill’s NPI, Dr.

Ayeni’s NPI, and as alleged herein, other LCSWs’ NPIs, when Ms. Spruill,

Dr. Ayeni and other such LCSWs did not provide (or supervise the provision

of) such services.

E. Delaware False Claims and Reporting Act

249. Under the DFCRA, any person who knowingly presents, or

causes to be presented a false or fraudulent claim for payment or approval; or

knowingly makes, uses or causes to be made or used a false record or

statement material to a false or fraudulent claim shall be liable to the State for

a civil penalty of not less than $10,957 and not more than $21,916, as adjusted

by the Federal Civil Penalties Inflation Adjustment Act of 2015, for each act

constituting a violation of this section, plus three times the amount of damages

which the State sustains because of the act of that person. 6 Del. C. § 1201(a).

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250. A person violating the DFCRA shall also be liable for the costs

of a civil action brought to recover any such penalties or damages, including

payment of reasonable attorney’s fees and costs. 6 Del. C. § 1201.

251. As alleged in more detail herein, Defendants knowingly violated

the DFCRA by presenting or causing to be presented false or fraudulent claims

for payment to State-funded insurance programs for payment or approval

and/or knowingly making, using or causing to be made or used false records

or statements material to false or fraudulent claims to State-funded insurance

programs related to services provided by unlicensed and unsupervised

Connections’ employees or agents using Ms. Spruill’s NPI, Dr. Ayeni’s NPI,

and as alleged herein, other LCSWs’ NPIs, when Ms. Spruill, Dr. Ayeni and

other such LCSWs did not provide (or supervise the provision of) such

services.

252. The FCA and the DFCRA both allow any person having

information about false or fraudulent claims to bring an action for herself, and

on behalf of the Government and the State, respectively, and to share in any

recovery. Relators seek through this action to recover all available damages,

civil penalties, and other relief for State and federal violations alleged herein.

253. Although the precise amount of the loss from Defendants’

misconduct alleged in this action cannot be determined prior to discovery, it

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is estimated that the damages and civil penalties that may be assessed against

Defendants under the facts alleged herein amount to millions of dollars.

ADDITIONAL FALSE CLAIMS ACT AND DELAWARE FALSE

CLAIMS AND REPORTING ACT ALLEGATIONS
254. Connections’ bill-to practice resulted in Connections’ unlicensed

employees and/or agents who were not supervised by Ms. Spruill or Dr. Ayeni

submitting claims for reimbursement to Medicaid and Medicare under Ms.

Spruill’s NPI and Dr. Ayeni’s NPI.

255. Here, Connections’ use of Ms. Spruill’s NPI and Dr. Ayeni’s NPI

failed to satisfy the plain meaning of the word “supervise” because neither

Ms. Spruill nor Dr. Ayeni directed nor inspected the work, actions, or

performance of, nor oversaw the work of the Connections’ employees and/or

agents who used their NPI, as described herein.

256. Currently, the Delaware Legislature, when credentialing mental

health screeners, defines “supervision of unlicensed mental health

professionals by a psychiatrist” as:

an unlicensed mental health professionals who need to work

under a psychiatrist licensed to practice medicine will perform
this work under their organization’s practice standards and
guidelines. This includes requirements that the credentialed
mental health screener discuss the individual in care’s issues
on the phone or through telepsychiatry with the supervising
psychiatrist at the time of the detainment decision and assuring
that this psychiatrist agrees and countersigns the decision
made. An electronically transmitted copy or original

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detainment form with the supervising psychiatrist’s signature

will need to be placed in the client’s medical record at the
facility or site where the detainment occurred within 24 hours.
257. The term “supervise,” in the context of a state’s Medicaid plans,

has been defined as “[t]o oversee,” “to have the oversight of, superintend the

execution or performance of (a thing)....”

258. Defendants submitted false claims to federal and state-funded

insurance program for payment for services provided by non-credentialed and

unsupervised providers who are not permitted to bill federal and state-funded

insurance programs for their services.

259. When submitting claims to federal and state-funded insurance

programs, Defendants’ certified that the claims were accurate, truthful and

complete.

260. The federal and state-funded insurance programs paid the false

or fraudulent claims based on Defendants’ certification that LCSWs were

providing these services and/or had supervised the provision of these services

when they did not.

261. In the instances where Dr. Ayeni’s NPI was used without Dr.

Ayeni seeing clients or supervising the provision of services, the federal and

state-funded insurance programs paid the false or fraudulent claims based on

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Defendants’ certification that physicians were providing these services and/or

had supervised the provision of these services when they did not.

262. Connections knowingly billed the Government, through its

Medicare and Medicaid programs, and Delaware, through its DSAMH

program, inter alia, for clients that do not have Medicaid or any other

insurance, and when Medicare or any other insurance company rejects its

claim, for services purportedly provided by Ms. Spruill, a LCSW, using Ms.

Spruill ’s NPI, that were not performed by Ms. Spruill, and were not

supervised by Ms. Spruill (or any other LCSW), and for Dr. Ayeni, a

physician, using his NPI that were not performed by nor supervised by Dr.

Ayeni. Instead, these services were provided by Connections’ unlicensed

agents or employees who are not entitled to bill Medicaid for their services

unless they are properly supervised by a LCSW or a physician. Such actions

were designed to state or imply that Ms. Spruill or Dr. Ayeni provided these

services to Connections’ clients and/or supervised the provision of these

services, which is untrue. Federal and/or State-funded insurance programs

unaware of the falsity or fraudulent nature of the claims caused by Defendants

remitted, and continue to remit, payment to Connections for these claims in

reliance on Connections’ certification that the claims it submits are truthful

and accurate.

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263. Connections knowingly made, used or caused to be made or used

false records or statements, such as the claims for reimbursement, and

presented, or caused to be presented, claims for reimbursement on forms, such

as the Form CMS-1500 and its electronic equivalent, which were material to

the Government’s and Delaware’s decisions to pay the claims, indicating Ms.

Spruill or Dr. Ayeni provided these services and/or supervised the provision

of these services when, in reality, Connections’ unlicensed and unsupervised

agents or employees provided these services. Such action was designed to

state or imply that Ms. Spruill or Dr. Ayeni provided these services to

Connections’ clients and/or supervised the provision of these services, which

is untrue. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

264. Defendants knowingly presented, or caused to be presented

claims for reimbursement and/or knowingly made, used or caused to be made

or used false records or statements, such as the claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, while falsely

certifying, inter alia: (a) the information they have submitted is truthful and

accurate; (b) the claim complies with all applicable Medicare and/or Medicaid

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laws, regulations and program instructions for payment; (c) the services

rendered were personally furnished by the provider listed on the claim or by

an employee under the provider’s supervision; and (d) the provider whose NPI

is listed on the claim was the primary individual rendering the services. See

Form CMS-1500. Federal and/or State-funded insurance programs unaware

of the falsity or fraudulent nature of the claims caused by Defendants remitted,

and continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

265. Defendants knowingly presented, or caused to be presented

claims for reimbursement and/or knowingly made, used or caused to be made

or used false records or statements, such as the claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, without

disclosing to the Government and the State that they violated regulations that

affected Connections’ eligibility for payment. For example, Connections

failed to disclose that unlicensed and unsupervised individuals provided the

services, rather than the providers whose NPIs are reflected on the claims for

reimbursement. Federal and/or State-funded insurance programs unaware of

the falsity or fraudulent nature of the claims caused by Defendants remitted,

and continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

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266. Defendants violated, and continue to violate, the FCA and the

DFCRA by knowingly submitting, causing to be submitted and continuing to

submit and cause to be submitted claims for reimbursement where the

Government and/or State has been provided with worthless services, instead

of the services paid for and required by the regulations. In addition,

Defendants violated, and continue to violate, the FCA and the DFCRA by

knowingly making, using, or causing to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, without disclosing to the

Government and the State that the Government and/or State has been provided

with worthless services, instead of the services paid for and required by the

regulations.

267. For example, instead of Ms. Spruill (or another LCSW)

providing the services for which Connections sought and obtained

reimbursement on the basis of the fraudulent use of Ms. Spruill’s NPI, an

unlicensed and unsupervised individual provided these services, and

Connections billed Medicare and/or Medicaid as if Ms. Spruill, a LCSW,

provided or supervised the provision of these services. By way of further

example, instead of Dr. Ayeni (or another physician) providing the services

for which Connections sought and obtained reimbursement on the basis of the

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fraudulent use of Dr. Ayeni’s NPI, an unlicensed and unsupervised individual

provided these services, and Connections billed Medicare and/or Medicaid as

if Dr. Ayeni, a physician, provided or supervised these services. As a result,

Federal and/or State-funded insurance programs unaware of the falsity or

fraudulent nature of the claims caused by Defendants remitted, and continue

to remit, payment to Connections for these claims in reliance on Connections’

certification that the claims it submits are truthful and accurate.

268. Defendant McKay has had knowledge that Connections’ agents

and employees were submitting these false and fraudulent claims since at least

prior to August 2013.

269. McKay abdicated her responsibility and authority to prevent or

correct the false billings, and as a result Connections obtained and continues

to obtain substantial financial benefit to the detriment of vulnerable

Delawareans.

270. McKay, as Connections’ founder, chief executive officer and

president, knew or had reason to know that Connections’ unlicensed and

unsupervised employees were submitting these false claims, and that

Connections is benefitting from these false claims while robbing Delawareans

of potentially life-saving resources.

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271. McKay knew, or had reason to know, that Connections

employees required clients to submit to medically unnecessary intakes as part

of MacKay and Connections’ campaign to increase revenue.

272. McKay knew, or had reason to know, that Connections

employees manipulated the length of services provided to Connections’

clients in Connections’ records to meet arbitrary billing targets designed to

pad Connections’ bottom line set by McKay through, inter alia, (i) seeing

clients for less than the time required to justify the reimbursement

Connections sought; (ii) double-booking clients; and (iii) fabricating time

records to make it appear as if they were treating clients when they had

clocked out and left the facility.

273. McKay knew, or had reason to know, that Connections

employees were dosing clients before they were seen by physicians or

licensed providers, which was against Connections’ policy, among other

things.

274. McKay knew, or had reason to know, that Connections

employees billed and were reimbursed by DSAMH and Medicaid for the same

claims, and did not return to either DSAMH or Medicaid the duplicative

reimbursement.

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275. McKay knew, or had reason to know, that Connections

employees billed Medicare knowing the claim for reimbursement would be

rejected, and then billed DSAMH.

276. McKay knew, or had reason to know, that Connections

employees unbundled IOP services when, for example, they failed to meet the

minimum nine hours of required weekly contact to increase Connections’

revenues.

277. McKay and others at Connections violated Connections’ policy

of not retaliating against employees for reporting suspected fraud by

terminating Ms. Spruill and Mr. Spruill.

278. After Ms. Spruill was terminated, Connections management sent

an email to the employees in the Dover and Harrington clinics instructing

them to no longer use Ms. Spruill as the “bill to” person.

279. Connections has knowledge that its agents and employees are

submitting these false claims, and that Connections is benefitting financially

from the false claims.

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COUNT I
Violation of the False Claims Act, 31 U.S.C. § 3729(a)(1)(A)
against All Defendants
280. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

281. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented, false or fraudulent claims to

the Government, through its Medicare and Medicaid programs, and Delaware,

through Medicaid and its DSAMH program. Such claims include claims for

services using Ms. Spruill’s NPI when the services were neither performed by

her nor supervised by her or any other LCSW. Instead, these services were

provided by Connections’ unlicensed agents or employees who are not

entitled to bill Medicaid for their services unless they are properly supervised

by a LCSW, such as Ms. Spruill. Such action was designed to state or imply

that Ms. Spruill provided these services to Connections’ clients and/or

supervised the provision of these services, which is untrue.

282. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented, false or fraudulent claims to

the Government, through is Medicare program, claims for services using Ms.

Spruill’s NPI when the services were not performed by her nor any other

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LCSW. Instead, these services were provided by Connections’ unlicensed

agents or employees who are not entitled to bill Medicare for their services.

Such action was designed to state or imply that Ms. Spruill provided these

services to Connections’ clients, which is untrue.

283. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, while falsely

certifying, inter alia: (a) the information they have submitted is truthful and

accurate; (b) the claim complies with all applicable Medicare and/or Medicaid

laws, regulations and program instructions for payment; (c) the services

rendered were personally furnished by the provider listed on the claim or by

an employee under the provider’s supervision; and (d) the provider whose NPI

is listed on the claim was the primary individual rendering the services.

284. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, without

disclosing to the Government and the State that they violated regulations that

affected Connections’ eligibility for payment. For example, Connections

represented that the services were provided by the providers whose NPIs are

reflected on the claims for reimbursement, and failed to disclose that

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unlicensed and unsupervised individuals provided the services. Thus,

Defendants’ failure to disclose their non-compliance with material statutory,

regulatory and/or contractual requirements made their representations

misleading half-truths.

285. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly

submitting, causing to be submitting and continuing to submit and cause to be

submitted claims for reimbursement where the Government and/or State has

been provided with worthless services, instead of the services paid for and

required by the regulations. For example, instead of Ms. Spruill (or another

LCSW) providing the services for which Connections sought and obtained

reimbursement on the basis of the fraudulent use of Ms. Spruill’s NPI, an

unlicensed and unsupervised individual provided these services, and

Connections billed Medicare and/or Medicaid as if Ms. Spruill, a LCSW,

provided or supervised the provision of these services.

286. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

state-funded insurance programs, indicating Ms. Spruill provided these

services and/or supervised the provision of these services when, in reality,

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Connections’ unlicensed and unsupervised agents or employees provided

these services.

287. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

288. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

289. Accordingly, Defendants are liable for treble damages, civil

penalties, and the costs of this action under 31 U.S.C. § 3729(a)(1) and (3).

COUNT II
Violation of the False Claims Act, 31 U.S.C. § 3729(a)(1)(B) against
all Defendants
290. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

291. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, including, but not limited to claims for reimbursement, and

submitted claims for reimbursement on forms such as the Form CMS-1500

and its electronic equivalent, and, as alleged above, to cause claims to be paid

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or approved by the Government, Delaware and/or federal and/or State-funded

insurance programs.

292. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, including, but not limited to claims for reimbursement, and

submitted claims for reimbursement for services provided to Medicare

recipients on forms such as the Form CMS-1500 and its electronic equivalent,

and, as alleged above, to cause claims to be paid or approved by the

Government, Delaware and/or federal and/or state-funded insurance

programs.

293. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, while falsely certifying, inter alia:

(a) the information they have submitted is truthful and accurate; (b) the claim

complies with all applicable Medicare and/or Medicaid laws, regulations and

program instructions for payment; (c) the services rendered were personally

furnished by the provider listed on the claim or by an employee under the

provider’s supervision; and (d) the provider whose NPI is listed on the claim

was the primary individual rendering the services.

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294. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, without disclosing to the

Government and the State that they violated regulations that affected

Connections’ eligibility for payment. For example, Connections represented

that the services were provided by the providers whose NPIs are reflected on

the claims for reimbursement, and failed to disclose that unlicensed and

unsupervised individuals provided the services. Thus, Defendants’ failure to

disclose their non-compliance with material statutory, regulatory and/or

contractual requirements made their representations misleading half-truths.

295. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly making,

using, or causing to be made or used false records or statements, such as the

claims for reimbursement on forms such as the Form CMS-1500 and its

electronic equivalent, without disclosing to the Government and the State that

the Government and/or State has been provided with worthless services,

instead of the services paid for and required by the regulations. For example,

instead of Ms. Spruill (or another LCSW) providing the services for which

Connections sought and obtained reimbursement on the basis of the fraudulent

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use of Ms. Spruill’s NPI, an unlicensed and unsupervised individual provided

these services, and Connections billed Medicare and/or Medicaid as if Ms.

Spruill, a LCSW, provided or supervised the provision of these services.

296. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

State-funded insurance programs, indicating Ms. Spruill provided these

services and/or supervised the provision of these services when, in reality,

Connections’ unlicensed and unsupervised agents or employees provided

these services.

297. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these records or statements were false.

298. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

299. Accordingly, Defendants are liable for treble damages, civil

penalties, and the costs of this action under 31 U.S.C. § 3729(a)(1) and (3).

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COUNT III
Violation of the Delaware False Claims and Reporting Act, 6 Del.
C. § 1201(a)(1) against All Defendants
300. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

301. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented, to the Government, through

its Medicaid program, and Delaware through its DSAMH program, claims for

services using Ms. Spruill’s NPI when the services were neither performed by

her nor supervised by her or any other LCSW. Instead, these services were

provided by Connections’ unlicensed agents or employees who are not

entitled to bill Medicaid for their services unless they are properly supervised

by a LCSW, such as Ms. Spruill. Such action was designed to state or imply

that Ms. Spruill provided these services to Connections’ clients and/or

supervised the provision of these services, which is untrue.

302. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, while falsely

certifying, inter alia: (a) the information they have submitted is truthful and

accurate; (b) the claim complies with all applicable Medicare and/or Medicaid

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laws, regulations and program instructions for payment; (c) the services

rendered were personally furnished by the provider listed on the claim or by

an employee under the provider’s supervision; and (d) the provider whose NPI

is listed on the claim was the primary individual rendering the services.

303. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, without

disclosing to the Government and the State that they violated regulations that

affected Connections’ eligibility for payment. For example, Connections

represented that the services were provided by the providers whose NPIs are

reflected on the claims for reimbursement, and failed to disclose that

unlicensed and unsupervised individuals provided the services. Thus,

Defendants’ failure to disclose their non-compliance with material statutory,

regulatory and/or contractual requirements made their representations

misleading half-truths.

304. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly

submitting, causing to be submitting and continuing to submit and cause to be

submitted claims for reimbursement where the Government and/or State has

been provided with worthless services, instead of the services paid for and

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required by the regulations. For example, instead of Ms. Spruill (or another

LCSW) providing the services for which Connections sought and obtained

reimbursement on the basis of the fraudulent use of Ms. Spruill’s NPI, an

unlicensed and unsupervised individual provided these services, and

Connections billed Medicare and/or Medicaid as if Ms. Spruill, a LCSW,

provided or supervised the provision of these services.

305. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

state-funded insurance programs, indicating Ms. Spruill provided these

services and/or supervised the provision of these services when, in reality,

Connections’ unlicensed and unsupervised agents or employees provided

these services.

306. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

307. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

308. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

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309. Accordingly, Defendants are liable for treble damages, civil

penalties and the cost of this action under 6 Del. C. § 1201(a).

COUNT IV
Violation of the Delaware False Claims and Reporting Act, 6 Del.
C. § 1201(a)(2) against All Defendants
310. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

311. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, including but not limited to claims for reimbursement, and

submitted claims for reimbursement on forms such as the Form CMS-1500

and its electronic equivalent, as alleged above, to cause claims to be paid or

approved by the Government, Delaware and/or federal and/or state-funded

insurance programs.

312. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, while falsely certifying, inter alia:

(a) the information they have submitted is truthful and accurate; (b) the claim

complies with all applicable Medicare and/or Medicaid laws, regulations and

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program instructions for payment; (c) the services rendered were personally

furnished by the provider listed on the claim or by an employee under the

provider’s supervision; and (d) the provider whose NPI is listed on the claim

was the primary individual rendering the services.

313. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, without disclosing to the

Government and the State that they violated regulations that affected

Connections’ eligibility for payment. For example, Connections represented

that the services were provided by the providers whose NPIs are reflected on

the claims for reimbursement, and failed to disclose that unlicensed and

unsupervised individuals provided the services. Thus, Defendants’ failure to

disclose their non-compliance with material statutory, regulatory and/or

contractual requirements made their representations misleading half-truths.

314. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly making,

using, or causing to be made or used false records or statements, such as the

claims for reimbursement on forms such as the Form CMS-1500 and its

electronic equivalent, without disclosing to the Government and the State that

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the Government and/or State has been provided with worthless services,

instead of the services paid for and required by the regulations. For example,

instead of Ms. Spruill (or another LCSW) providing the services for which

Connections sought and obtained reimbursement on the basis of the fraudulent

use of Ms. Spruill’s NPI, an unlicensed and unsupervised individual provided

these services, and Connections billed Medicare and/or Medicaid as if Ms.

Spruill, a LCSW, provided or supervised the provision of these services.

315. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

state-funded insurance programs, indicating Ms. Spruill provided these

services and/or supervised the provision of these services when, in reality,

Connections unlicensed and supervised agents or employees provided these

services.

316. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

317. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

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318. Accordingly, Defendants are liable for treble damages, civil

penalties and the cost of this action under 6 Del. C. § 1201(a).

COUNT V
Violation of the False Claims Act, 31 U.S.C. § 3729(a)(1)(A)
against All Defendants
319. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein .

320. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented, false or fraudulent claims to

the Government, through its Medicare and Medicaid programs, and Delaware,

through Medicaid and its DSAMH program. Such claims include claims for

services using Dr. Ayeni’s NPI when the services were neither performed by

Dr. Ayeni nor supervised by him or any other physician. Instead, these

services were provided by Connections’ unlicensed agents or employees who

are not entitled to bill Medicaid for their services unless they are properly

supervised by a physician, such as Dr. Ayeni. Such action was designed to

state or imply that Dr. Ayeni provided these services to Connections’ clients

and/or supervised the provision of these services, which is untrue.

321. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented, false or fraudulent claims to

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the Government, through is Medicare program, claims for services using Dr.

Ayeni’s NPI when the services were not performed by him nor any other

physician. Instead, these services were provided by Connections’ unlicensed

agents or employees who are not entitled to bill Medicare for their services.

Such action was designed to state or imply that Dr. Ayeni provided these

services to Connections’ clients, which is untrue.

322. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, while falsely

certifying, inter alia: (a) the information they have submitted is truthful and

accurate; (b) the claim complies with all applicable Medicare and/or Medicaid

laws, regulations and program instructions for payment; (c) the services

rendered were personally furnished by the provider listed on the claim or by

an employee under the provider’s supervision; and (d) the provider whose NPI

is listed on the claim was the primary individual rendering the services.

323. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, without

disclosing to the Government and the State that they violated regulations that

affected Connections’ eligibility for payment. For example, Connections

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represented that the services were provided by the providers whose NPIs are

reflected on the claims for reimbursement, and failed to disclose that

unlicensed and unsupervised individuals provided the services. Thus,

Defendants’ failure to disclose their non-compliance with material statutory,

regulatory and/or contractual requirements made their representations

misleading half-truths.

324. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly

submitting, causing to be submitting and continuing to submit and cause to be

submitted claims for reimbursement where the Government and/or State has

been provided with worthless services, instead of the services paid for and

required by the regulations. For example, instead of Dr. Ayeni (or another

physician) providing the services for which Connections sought and obtained

reimbursement on the basis of the fraudulent use of Dr. Ayeni’s NPI, an

unlicensed and unsupervised individual provided these services, and

Connections billed Medicare and/or Medicaid as if Dr. Ayeni, a physician,

provided or supervised the provision of these services.

325. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

state-funded insurance programs, indicating Dr. Ayeni provided these

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services and/or supervised the provision of these services when, in reality,

Connections’ unlicensed and unsupervised agents or employees provided

these services.

326. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

327. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

328. Accordingly, Defendants are liable for treble damages, civil

penalties, and the costs of this action under 31 U.S.C. § 3729(a)(1) and (3).

COUNT VI
Violation of the False Claims Act, 31 U.S.C. § 3729(a)(1)(B)
against all Defendants
329. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

330. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, including, but not limited to claims for reimbursement, and

submitted claims for reimbursement on forms such as the Form CMS-1500

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and its electronic equivalent, and, as alleged above, to cause claims to be paid

or approved by the Government, Delaware and/or federal and/or State-funded

insurance programs.

331. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, including, but not limited to claims for reimbursement, and

submitted claims for reimbursement for services provided to Medicare

recipients on forms such as the Form CMS-1500 and its electronic equivalent,

and, as alleged above, to cause claims to be paid or approved by the

Government, Delaware and/or federal and/or state-funded insurance

programs.

332. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, while falsely certifying, inter alia:

(a) the information they have submitted is truthful and accurate; (b) the claim

complies with all applicable Medicare and/or Medicaid laws, regulations and

program instructions for payment; (c) the services rendered were personally

furnished by the provider listed on the claim or by an employee under the

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provider’s supervision; and (d) the provider whose NPI is listed on the claim

was the primary individual rendering the services.

333. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, without disclosing to the

Government and the State that they violated regulations that affected

Connections’ eligibility for payment. For example, Connections represented

that the services were provided by the providers whose NPIs are reflected on

the claims for reimbursement, and failed to disclose that unlicensed and

unsupervised individuals provided the services. Thus, Defendants’ failure to

disclose their non-compliance with material statutory, regulatory and/or

contractual requirements made their representations misleading half-truths.

334. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly making,

using, or causing to be made or used false records or statements, such as the

claims for reimbursement on forms such as the Form CMS-1500 and its

electronic equivalent, without disclosing to the Government and the State that

the Government and/or State has been provided with worthless services,

instead of the services paid for and required by the regulations. For example,

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instead of Dr. Ayeni (or another physician) providing the services for which

Connections sought and obtained reimbursement on the basis of the fraudulent

use of Dr. Ayeni’s NPI, an unlicensed and unsupervised individual provided

these services, and Connections billed Medicare and/or Medicaid as if Dr.

Ayeni, a physician, provided or supervised the provision of these services.

335. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

State-funded insurance programs, indicating Dr. Ayeni provided these

services and/or supervised the provision of these services when, in reality,

Connections’ unlicensed and unsupervised agents or employees provided

these services.

336. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these records or statements were false.

337. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

338. Accordingly, Defendants are liable for treble damages, civil

penalties, and the costs of this action under 31 U.S.C. § 3729(a)(1) and (3).

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COUNT VII
Violation of the Delaware False Claims and Reporting Act, 6 Del. C.
§ 1201(a)(1) against All Defendants
339. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

340. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented, to the Government, through

its Medicaid program, and Delaware through its DSAMH program, claims for

services using Dr. Ayeni’s NPI when the services were neither performed by

him nor supervised by him or any other physician. Instead, these services

were provided by Connections’ unlicensed agents or employees who are not

entitled to bill Medicaid for their services unless they are properly supervised

by a physician, such as Dr. Ayeni. Such action was designed to state or imply

that Dr. Ayeni provided these services to Connections’ clients and/or

supervised the provision of these services, which is untrue.

341. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, while falsely

certifying, inter alia: (a) the information they have submitted is truthful and

accurate; (b) the claim complies with all applicable Medicare and/or Medicaid

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laws, regulations and program instructions for payment; (c) the services

rendered were personally furnished by the provider listed on the claim or by

an employee under the provider’s supervision; and (d) the provider whose NPI

is listed on the claim was the primary individual rendering the services.

342. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, without

disclosing to the Government and the State that they violated regulations that

affected Connections’ eligibility for payment. For example, Connections

represented that the services were provided by the providers whose NPIs are

reflected on the claims for reimbursement, and failed to disclose that

unlicensed and unsupervised individuals provided the services. Thus,

Defendants’ failure to disclose their non-compliance with material statutory,

regulatory and/or contractual requirements made their representations

misleading half-truths.

343. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly

submitting, causing to be submitting and continuing to submit and cause to be

submitted claims for reimbursement where the Government and/or State has

been provided with worthless services, instead of the services paid for and

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required by the regulations. For example, instead of Dr. Ayeni (or another

physician) providing the services for which Connections sought and obtained

reimbursement on the basis of the fraudulent use of Dr. Ayeni’s NPI, an

unlicensed and unsupervised individual provided these services, and

Connections billed Medicare and/or Medicaid as if Dr. Ayeni, a physician,

provided or supervised the provision of these services.

344. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

state-funded insurance programs, indicating Dr. Ayeni provided these

services and/or supervised the provision of these services when, in reality,

Connections’ unlicensed and unsupervised agents or employees provided

these services.

345. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

346. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

347. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

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348. Accordingly, Defendants are liable for treble damages, civil

penalties and the cost of this action under 6 Del. C. § 1201(a).

COUNT VIII
Violation of the Delaware False Claims and Reporting Act,
6 Del. C. § 1201(a)(2) against All Defendants
349. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

350. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, including but not limited to claims for reimbursement, and

submitted claims for reimbursement on forms such as the Form CMS-1500

and its electronic equivalent, as alleged above, to cause claims to be paid or

approved by the Government, Delaware and/or federal and/or state-funded

insurance programs.

351. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, while falsely certifying, inter alia:

(a) the information they have submitted is truthful and accurate; (b) the claim

complies with all applicable Medicare and/or Medicaid laws, regulations and

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program instructions for payment; (c) the services rendered were personally

furnished by the provider listed on the claim or by an employee under the

provider’s supervision; and (d) the provider whose NPI is listed on the claim

was the primary individual rendering the services.

352. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, without disclosing to the

Government and the State that they violated regulations that affected

Connections’ eligibility for payment. For example, Connections represented

that the services were provided by the providers whose NPIs are reflected on

the claims for reimbursement, and failed to disclose that unlicensed and

unsupervised individuals provided the services. Thus, Defendants’ failure to

disclose their non-compliance with material statutory, regulatory and/or

contractual requirements made their representations misleading half-truths.

353. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly making,

using, or causing to be made or used false records or statements, such as the

claims for reimbursement on forms such as the Form CMS-1500 and its

electronic equivalent, without disclosing to the Government and the State that

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the Government and/or State has been provided with worthless services,

instead of the services paid for and required by the regulations. For example,

instead of Dr. Ayeni (or another physician) providing the services for which

Connections sought and obtained reimbursement on the basis of the fraudulent

use of Ms. Spruill’s NPI, an unlicensed and unsupervised individual provided

these services, and Connections billed Medicare and/or Medicaid as if Dr.

Ayeni, a physician, provided or supervised the provision of these services.

354. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

state-funded insurance programs, indicating Dr. Ayeni provided these

services and/or supervised the provision of these services when, in reality,

Connections unlicensed and supervised agents or employees provided these

services.

355. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

356. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

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357. Accordingly, Defendants are liable for treble damages, civil

penalties and the cost of this action under 6 Del. C. § 1201(a).

COUNT IX
Violation of the False Claims Act, 31 U.S.C. § 3729(a)(1)(A)
against All Defendants
358. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

359. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented, false or fraudulent claims to

the Government, through its Medicare and Medicaid programs, and Delaware,

through Medicaid and its DSAMH program, including, inter alia,

(i) fabricating medical records; (ii) concealing their noncompliance from

external auditors; (iii) submitting claims for reimbursement for medically

unnecessary intake sessions; (iv) manipulating the length of services provided

in billing records to reflect more time than Connections’ providers actually

spent with the clients; (v) double-booking clients; (vi) fabricating time

records; (vii) dosing clients before they are evaluated by a physician and a

licensed counselor and submitting reimbursement for such services;

(viii) submitting the same claims for reimbursement to DSAMH and

Medicaid and receiving reimbursement from both, (ix) submitting claims to

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Medicare knowing those claims would be rejected before submitting them to

DSAMH, and (x) unbundling MAT services to increase its reimbursement, all

designed to increase Connections’ bottom line rather than provide any

additional care to Connections’ clients.

360. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, while falsely

certifying, inter alia: (a) the information they have submitted is truthful and

accurate and (b) the claim complies with all applicable Medicare and/or

Medicaid laws, regulations and program instructions for payment.

361. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, without

disclosing to the Government and the State that they violated regulations that

affected Connections’ eligibility for payment. For example, Connections

represented that the services were medically necessary and failed to disclose

these clients had previously participated in an intake session and the additional

intake was unnecessary and designed to increase Connections’ revenue. In

addition, Connections: (i) fabricated medical records; (ii) concealed their

noncompliance from external auditors; (iii) manipulated the length of services

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provided in billing records to reflect more time than Connections’ providers

actually spent with the clients; (iv) double-booked clients; (v) fabricated time

records; (vi) dosed clients before they are evaluated by a physician and a

licensed counselor and submitting reimbursement for such services;

(vii) submitted the same claims for reimbursement to DSAMH and Medicaid

and receiving reimbursement from both, (viii) submitted claims to Medicare

knowing those claims would be rejected before submitting them to DSAMH,

and (ix) unbundled MAT services to increase its reimbursement, all designed

to increase Connections’ bottom line rather than provide any additional care

to Connections’ clients. to increase its bottom line rather than provide any

additional care to Connections’ clients. Thus, Defendants’ failure to disclose

their non-compliance with material statutory, regulatory and/or contractual

requirements made their representations misleading half-truths.

362. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly

submitting, causing to be submitting and continuing to submit and cause to be

submitted claims for reimbursement where the Government and/or State has

been provided with worthless services, instead of the services paid for and

required by the regulations. For example, Connections represented that the

intake sessions were medically necessary and failed to disclose that these

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clients had previously participated in an intake session and the additional

intake was unnecessary and designed to increase Connections’ revenue. In

addition, Connections: (i) fabricated medical records; (ii) concealed their

noncompliance from external auditors; (iii) manipulated the length of services

provided in billing records to reflect more time than Connections’ providers

actually spent with the clients; (iv) double-booked clients; (v) fabricated time

records; (vi) dosed clients before they are evaluated by a physician and a

licensed counselor and submitting reimbursement for such services;

(vii) submitted the same claims for reimbursement to DSAMH and Medicaid

and receiving reimbursement from both, (viii) submitted claims to Medicare

knowing those claims would be rejected before submitting them to DSAMH,

and (ix) unbundled MAT services to increase its reimbursement, to increase

its bottom line rather than provide any additional care to Connections’ clients.

363. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

state-funded insurance programs, indicating these intakes were medically

necessary when, in reality, they were part of Connections’ revenue-generating

machine.

364. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

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365. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

366. Accordingly, Defendants are liable for treble damages, civil

penalties, and the costs of this action under 31 U.S.C. § 3729(a)(1) and (3).

COUNT X
Violation of the False Claims Act, 31 U.S.C. § 3729(a)(1)(B)
against all Defendants
367. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

368. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, including, but not limited to claims for reimbursement, and

submitted claims for reimbursement on forms such as the Form CMS-1500

and its electronic equivalent, and, as alleged above, to cause claims to be paid

or approved by the Government, Delaware and/or federal and/or State-funded

insurance programs.

369. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

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statements, including, but not limited to claims for reimbursement, and

submitted claims for reimbursement for services provided to Medicare

recipients on forms such as the Form CMS-1500 and its electronic equivalent,

and, as alleged above, to cause claims to be paid or approved by the

Government, Delaware and/or federal and/or state-funded insurance

programs.

370. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, while falsely certifying, inter alia:

(a) the information they have submitted is truthful and accurate and (b) the

claim complies with all applicable Medicare and/or Medicaid laws,

regulations and program instructions for payment.

371. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, without disclosing to the

Government and the State that they violated regulations that affected

Connections’ eligibility for payment. For example, Connections represented

that the intake services were medically necessary and failed to disclose these

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clients had previously participated in an intake session and the additional

intake was unnecessary and designed to increase Connections’ revenue. In

addition, Connections: (i) fabricated medical records; (ii) concealed their

noncompliance from external auditors; (iii) manipulated the length of services

provided in billing records to reflect more time than Connections’ providers

actually spent with the clients; (iv) double-booked clients; (v) fabricated time

records; (vi) dosed clients before they are evaluated by a physician and a

licensed counselor and submitting reimbursement for such services; (vii)

submitted the same claims for reimbursement to DSAMH and Medicaid and

receiving reimbursement from both, (viii) submitted claims to Medicare

knowing those claims would be rejected before submitting them to DSAMH,

and (ix) unbundled MAT services to increase its reimbursement, to increase

its bottom line rather than provide any additional care to Connections’ clients.

Thus, Defendants’ failure to disclose their non-compliance with material

statutory, regulatory and/or contractual requirements made their

representations misleading half-truths.

372. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly making,

using, or causing to be made or used false records or statements, such as the

claims for reimbursement on forms such as the Form CMS-1500 and its

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electronic equivalent, without disclosing to the Government and the State that

the Government and/or State has been provided with worthless services,

instead of the services paid for and required by the regulations. For example,

Connections represented that the intake sessions were medically necessary

and failed to disclose that these clients had previously participated in an intake

session and the additional intake was unnecessary and designed to increase

Connections’ revenue. Similarly, Connections: (i) fabricated medical

records; (ii) concealed their noncompliance from external auditors;

(iii) manipulated the length of services provided in billing records to reflect

more time than Connections’ providers actually spent with the clients;

(iv) double-booked clients; (v) fabricated time records; (vi) dosed clients

before they are evaluated by a physician and a licensed counselor and

submitting reimbursement for such services; (vii) submitted the same claims

for reimbursement to DSAMH and Medicaid and receiving reimbursement

from both, (viii) submitted claims to Medicare knowing those claims would

be rejected before submitting them to DSAMH, and (ix) unbundled MAT

services to increase its reimbursement, to increase its bottom line rather than

provide any additional care to Connections’ clients.

373. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

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State-funded insurance programs, indicating these intakes were medically

necessary when, in reality, they were part of Connections’ revenue-generating

machine. Similarly, these false records or statements were material to false

or fraudulent claims made to the Government, Delaware and/or federal and/or

State-funded insurance programs, indicating: the length of services provided

were accurately reflected in Connections’ records when they were not and

Connections’ providers treated clients when its records reflected these clients

were treated. Moreover, by submitting reimbursements to DSAMH,

Medicaid and Medicare, Connections was falsely indicating that it had the

right to be paid by DSAMH, Medicaid and/or Medicare but not both DSAMH

and Medicaid for the same claim, and not Medicare when the claims was not

eligible for reimbursement by Medicare.

374. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these records or statements were false.

375. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

376. Accordingly, Defendants are liable for treble damages, civil

penalties, and the costs of this action under 31 U.S.C. § 3729(a)(1) and (3).

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COUNT XI
Violation of the Delaware False Claims and Reporting Act,
6 Del. C. § 1201(a)(1) against All Defendants
377. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

378. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented, false or fraudulent claims to

the Government, through its Medicare and Medicaid programs, and Delaware,

through Medicaid and its DSAMH program, including, inter alia,

(i) fabricating medical records; (ii) concealing their noncompliance from

external auditors; (iii) submitting claims for reimbursement for medically

unnecessary intake sessions; (iv) manipulating the length of services provided

in billing records to reflect more time than Connections’ providers actually

spent with the clients; (v) double-booking clients; (vi) fabricating time

records; (vii) dosing clients before they are evaluated by a physician and a

licensed counselor and submitting reimbursement for such services;

(viii) submitting the same claims for reimbursement to DSAMH and

Medicaid and receiving reimbursement from both, (ix) submitting claims to

Medicare knowing those claims would be rejected before submitting them to

DSAMH, and (x) unbundling MAT services to increase its reimbursement, all

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designed to increase Connections’ bottom line rather than provide any

additional care to Connections’ clients.

379. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, while falsely

certifying, inter alia: (a) the information they have submitted is truthful and

accurate; and (b) the claim complies with all applicable Medicare and/or

Medicaid laws, regulations and program instructions for payment.

380. Through the acts described in this Complaint, Defendants

knowingly presented, or caused to be presented claims for reimbursement on

forms such as the Form CMS-1500 and its electronic equivalent, without

disclosing to the Government and the State that they violated regulations that

affected Connections’ eligibility for payment. For example, Connections

represented that the intake services were medically necessary and failed to

disclose these clients had previously participated in an intake session and the

additional intake was unnecessary and designed to increase Connections’

revenue. In addition, Connections: (i) fabricated medical records;

(ii) concealed their noncompliance from external auditors; (iii) manipulated

the length of services provided in billing records to reflect more time than

Connections’ providers actually spent with the clients; (iv) double-booked

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clients; (v) fabricated time records; (vi) dosed clients before they are evaluated

by a physician and a licensed counselor and submitting reimbursement for

such services; (vii) submitted the same claims for reimbursement to DSAMH

and Medicaid and receiving reimbursement from both, (viii) submitted claims

to Medicare knowing those claims would be rejected before submitting them

to DSAMH, and (ix) unbundled MAT services to increase its reimbursement,

to increase its bottom line rather than provide any additional care to

Connections’ clients. Thus, Defendants’ failure to disclose their non-

compliance with material statutory, regulatory and/or contractual

requirements made their representations misleading half-truths.

381. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly

submitting, causing to be submitting and continuing to submit and cause to be

submitted claims for reimbursement where the Government and/or State has

been provided with worthless services, instead of the services paid for and

required by the regulations. For example, Connections represented that the

intake sessions were medically necessary and failed to disclose that these

clients had previously participated in an intake session and the additional

intake was unnecessary and designed to increase Connections’ revenue. In

addition, Connections: (i) fabricated medical records; (ii) concealed their

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noncompliance from external auditors; (iii) manipulated the length of services

provided in billing records to reflect more time than Connections’ providers

actually spent with the clients; (iv) double-booked clients; (v) fabricated time

records; (vi) dosed clients before they are evaluated by a physician and a

licensed counselor and submitting reimbursement for such services; (vii)

submitted the same claims for reimbursement to DSAMH and Medicaid and

receiving reimbursement from both, (viii) submitted claims to Medicare

knowing those claims would be rejected before submitting them to DSAMH,

and (ix) unbundled MAT services to increase its reimbursement, to increase

its bottom line rather than provide any additional care to Connections’ clients.

382. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

state-funded insurance programs, indicating these intakes were medically

necessary when, in reality, they were part of Connections’ revenue-generating

machine.

383. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

384. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

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385. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

386. Accordingly, Defendants are liable for treble damages, civil

penalties and the cost of this action under 6 Del. C. § 1201(a).

COUNT XII
Violation of the Delaware False Claims and Reporting Act,
6 Del. C. § 1201(a)(2) against All Defendants
387. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

388. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, including but not limited to claims for reimbursement, and

submitted claims for reimbursement on forms such as the Form CMS-1500

and its electronic equivalent, as alleged above, to cause claims to be paid or

approved by the Government, Delaware and/or federal and/or state-funded

insurance programs.

389. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

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statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, while falsely certifying, inter alia:

(a) the information they have submitted is truthful and accurate and (b) the

claim complies with all applicable Medicare and/or Medicaid laws,

regulations and program instructions for payment.

390. Through the acts described in this Complaint, Defendants

knowingly made, used, or caused to be made or used false records or

statements, such as the claims for reimbursement on forms such as the Form

CMS-1500 and its electronic equivalent, without disclosing to the

Government and the State that they violated regulations that affected

Connections’ eligibility for payment. For example, Connections represented

that the intake services were medically necessary and failed to disclose these

clients had previously participated in an intake session and the additional

intake was unnecessary and designed to increase Connections’ revenue. In

addition, Connections: (i) fabricated medical records; (ii) concealed their

noncompliance from external auditors; (iii) manipulated the length of services

provided in billing records to reflect more time than Connections’ providers

actually spent with the clients; (iv) double-booked clients; (v) fabricated time

records; (vi) dosed clients before they are evaluated by a physician and a

licensed counselor and submitting reimbursement for such services;

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(vii) submitted the same claims for reimbursement to DSAMH and Medicaid

and receiving reimbursement from both, (viii) submitted claims to Medicare

knowing those claims would be rejected before submitting them to DSAMH,

and (ix) unbundled MAT services to increase its reimbursement, to increase

its bottom line rather than provide any additional care to Connections’ clients.

Thus, Defendants’ failure to disclose their non-compliance with material

statutory, regulatory and/or contractual requirements made their

representations misleading half-truths.

391. Through the acts described in this Complaint, Defendants

violated, and continue to violate, the FCA and DFCRA by knowingly making,

using, or causing to be made or used false records or statements, such as the

claims for reimbursement on forms such as the Form CMS-1500 and its

electronic equivalent, without disclosing to the Government and the State that

the Government and/or State has been provided with worthless services,

instead of the services paid for and required by the regulations. For example,

Connections represented that the intake sessions were medically necessary

and failed to disclose that these clients had previously participated in an intake

session and the additional intake was unnecessary and designed to increase

Connections’ revenue. Similarly, Connections: (i) fabricated medical records;

(ii) concealed their noncompliance from external auditors; (iii) manipulated

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the length of services provided in billing records to reflect more time than

Connections’ providers actually spent with the clients; (iv) double-booked

clients; (v) fabricated time records; (vi) dosed clients before they are evaluated

by a physician and a licensed counselor and submitting reimbursement for

such services; (vii) submitted the same claims for reimbursement to DSAMH

and Medicaid and receiving reimbursement from both, (viii) submitted claims

to Medicare knowing those claims would be rejected before submitting them

to DSAMH, and (ix) unbundled MAT services to increase its reimbursement,

to increase its bottom line rather than provide any additional care to

Connections’ clients.

392. These false records or statements were material to false or

fraudulent claims made to the Government, Delaware and/or federal and/or

state-funded insurance programs, indicating these intakes were medically

necessary when, in reality, they were part of Connections’ revenue-generating

machine.

393. Defendants knew, or were deliberately ignorant or reckless in not

knowing, that these claims were false.

394. Federal and/or State-funded insurance programs unaware of the

falsity or fraudulent nature of the claims caused by Defendants, remitted, and

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continue to remit, payment to Connections for these claims in reliance on

Connections’ certification that the claims it submits are truthful and accurate.

395. Accordingly, Defendants are liable for treble damages, civil

penalties and the cost of this action under 6 Del. C. § 1201(a).

Count XIII
Retaliation in Violation of 31 U.S.C. § 3730(h)(1)
against All Defendants
396. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

397. The False Claims Act, 31 U.S.C. § 3730(h) provides:

(h) Relief From Retaliatory Actions.—

(1) In general.—
Any employee, contractor, or agent shall be entitled to all
relief necessary to make that employee, contractor, or agent
whole, if that employee, contractor, or agent is discharged,
demoted, suspended, threatened, harassed, or in any other
manner discriminated against in the terms and conditions of
employment because of lawful acts done by the employee,
contractor, agent or associated others in furtherance of an
action under this section or other efforts to stop 1 or more
violations of this subchapter.
(2) Relief.—
Relief under paragraph (1) shall include reinstatement with the
same seniority status that employee, contractor, or agent
would have had but for the discrimination, 2 times the amount
of back pay, interest on the back pay, and compensation for
any special damages sustained as a result of the
discrimination, including litigation costs and reasonable

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attorneys’ fees. An action under this subsection may be

brought in the appropriate district court of the United States
for the relief provided in this subsection.
398. Defendants have an obligation under the False Claims Act to

refrain from taking any retaliatory actions against employees for attempting

to report or stop fraud pursuant to 31 U.S.C. § 3730(h).

399. Ms. Spruill engaged in protected activity through her efforts to

stop Defendants from presenting or causing to presented false or fraudulent

claims for reimbursement to the Medicare and Medicaid programs and/or

knowingly making, using or causing to be made or used false records or

statements material to false or fraudulent claims to the Medicare and Medicaid

programs for reimbursement that use Ms. Spruill’s NPI, which are designed

to state or imply that Ms. Spruill provided or supervised the provision of the

services to Connections’ clients, notwithstanding that, in fact, unlicensed and

unsupervised providers, who are not entitled to bill for their services, provided

these services, in an attempt to cause, and in fact causing, the Government and

Delaware to pay out more money than they owe for these services.

400. When Ms. Spruill first learned others at Connections were using

her as the “bill to” person even though she was not supervising them, she

questioned Connections’ Director of Human Resources as to why people she

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did not supervise were using her NPI. Approximately three weeks later, she

was terminated by Connections without having her concerns addressed.

401. After being re-hired by Connections, Ms. Spruill asked her

supervisor if she was aware of who, if anyone at Connections, was choosing

her as the “bill to” person within EHR and thus causing Ms. Spruill to be listed

as the rendering provider on the claims submitted for payment to the

Government and/or Delaware. Ms. Spruill also called Health Options to ask

about the use of her NPI by individuals other than herself. Within two months

of Ms. Spruill making these inquiries, McKay requested a meeting with Ms.

Spruill and Connections’ Human Resources Department. At this meeting, Ms.

Spruill was initially told she was being demoted to a therapist position, and

was ultimately offered a position providing “clinical chart supervision” over

Connections’ employees from a remove Middletown location. Following this

meeting, Ms. Spruill’s supervisor became aggressive and hostile to her. In

November 2018, Connections again terminated Ms. Spruill.

402. After Ms. Spruill highlighted Defendants’ fraudulent “bill to”

practices, she was threatened, harassed, and discriminated against in the terms

and conditions of her employment because of the lawful acts she took to stop

Defendants’ further violations of the False Claims Act.

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403. In acting to stop Defendants from using her NPI to submit a False

Claim to the Government and/or Delaware, Ms. Spruill made an effort “to

stop 1 or more violations” of the False Claims Act.

404. Ms. Spruill’s actions were protected activity within the meaning

of 31 U.S.C. § 3730(h)(1).

405. Defendants were aware that Ms. Spruill was engaged in protected

activity.

406. Pursuant to 31 U.S.C. § 3730(h)(2), Ms. Spruill is entitled to two

times the amount of back pay, interest on the back pay, and compensation for

any special damages sustained as a result of the discrimination, including

litigation costs and reasonable attorneys’ fees.

Count XIV
Retaliation in Violation of 6 Del. C. § 1208
against All Defendants
407. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

408. The DFCRA, 6 Del. C. § 1208 provides:

(a) Any employee, contractor, or agent shall be entitled to all

relief necessary to make that employee, contractor, or agent
whole, if that employee, contractor, or agent is discharged,
demoted, suspended, threatened, harassed, or in any other
manner discriminated against in the terms and conditions of
employment because of lawful acts done by the employee,

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contractor, agent or associated others in furtherance of an

action under this chapter or other efforts to stop 1 or more
violations of this chapter.
Such relief shall include reinstatement with the same seniority
status that employee, contractor, or agent would have had but
for the discrimination, 2 times the amount of back pay, interest
on the back pay, and compensation for any special damages
sustained as a result of the discrimination, including litigation
costs and reasonable attorneys' fees. . . .
409. Defendants have an obligation under the DFCRA to refrain from

taking any retaliatory actions against employees for attempting to report or

stop fraud pursuant to 6 Del. C. § 1208.

410. Ms. Spruill engaged in protected activity through her efforts to

stop Defendants from presenting or causing to presented false or fraudulent

claims for reimbursement to the Medicare and Medicaid programs and/or

knowingly making, using or causing to be made or used false records or

statements material to false or fraudulent claims to the Medicare and Medicaid

programs for reimbursement that use Ms. Spruill’s NPI, which are designed

to state or imply that Ms. Spruill provided or supervised the provision of the

services to Connections’ clients, notwithstanding that, in fact, unlicensed and

unsupervised providers, who are not entitled to bill for their services, provided

these services, in an attempt to cause, and in fact causing, the Government and

Delaware to pay out more money than they owe for these services.

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411. When Ms. Spruill first learned others at Connections were using

her as the “bill to” person even though she was not supervising them, she

questioned Connections’ Director of Human Resources as to why people she

did not supervise were using her NPI. Approximately three weeks later, she

was terminated by Connections without having her concerns addressed.

412. After being re-hired by Connections, Ms. Spruill asked her

supervisor if she was aware of who, if anyone at Connections, was choosing

her as the “bill to” person within EHR and thus causing Ms. Spruill to be listed

as the rendering provider on the claims submitted for payment to the

Government and/or Delaware. Ms. Spruill also called Health Options to ask

about the use of her NPI by individuals other than herself. Within two months

of Ms. Spruill making these inquiries, McKay requested a meeting with Ms.

Spruill and Connections’ Human Resources Department. At this meeting, Ms.

Spruill was initially told she was being demoted to a therapist position, and

was ultimately offered a position providing “clinical chart supervision” over

Connections’ employees from a remove Middletown location. Following this

meeting, Ms. Spruill’s supervisor became aggressive and hostile to Ms.

Spruill. In November 2018, Connections again terminated Ms. Spruill.

413. After Ms. Spruill highlighted Defendants’ fraudulent “bill to”

practices, she was discharged, demoted, suspended, threatened, harassed, and

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discriminated against in the terms and conditions of her employment because

of the lawful acts she took to stop Defendants’ further violations of the

DFCRA.

414. In acting to stop Defendants from using her NPI to submit a False

Claim to the Government and/or Delaware, Ms. Spruill made an effort “to

stop 1 or more violations” of the DFCRA.

415. Ms. Spruill’s actions were protected activity within the meaning

of 6 Del. C. § 1208.

416. Defendants were aware that Ms. Spruill was engaged in protected

activity.

417. Pursuant to 6 Del. C. § 1208, Ms. Spruill is entitled to two times

the amount of back pay, interest on the back pay, and compensation for any

special damages sustained as a result of the discrimination, including litigation

costs and reasonable attorneys' fees.

Count XV
Retaliation in Violation of 31 U.S.C. § 3730(h)(1)
against All Defendants
418. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

The False Claims Act, 31 U.S.C. § 3730(h) provides:

(h) Relief From Retaliatory Actions.—

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(1) In general.—
Any employee, contractor, or agent shall be entitled to all
relief necessary to make that employee, contractor, or agent
whole, if that employee, contractor, or agent is discharged,
demoted, suspended, threatened, harassed, or in any other
manner discriminated against in the terms and conditions of
employment because of lawful acts done by the employee,
contractor, agent or associated others in furtherance of an
action under this section or other efforts to stop 1 or more
violations of this subchapter.
(2) Relief.—
Relief under paragraph (1) shall include reinstatement with the
same seniority status that employee, contractor, or agent
would have had but for the discrimination, 2 times the amount
of back pay, interest on the back pay, and compensation for
any special damages sustained as a result of the
discrimination, including litigation costs and reasonable
attorneys’ fees. An action under this subsection may be
brought in the appropriate district court of the United States
for the relief provided in this subsection.
419. Defendants have an obligation under the False Claims Act to

refrain from taking any retaliatory actions against employees for attempting

to report or stop fraud pursuant to 31 U.S.C. § 3730(h).

420. Mr. Spruill engaged in protected activity through his efforts to

stop Defendants’ fraudulent practices, inter alia, by voicing his objections to

his superiors to Defendants’ fraudulent billing practices and the sub-par levels

of care at the Harrington clinic that failed to meet regulatory requirements.

421. Mr. Spruill has been a vocal critic of Defendants’ fraudulent

practices, including by revealing the fraudulent billing practices and the sub-

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par levels of care at the Harrington clinic that failed to meet regulatory

requirements.

422. After Mr. Spruill highlighted Defendants’ fraudulent billing

practices and the Harrington clinic’s failure to comply with required

regulations, he was threatened, harassed, and discriminated against in the

terms and conditions of his employment because of the lawful acts he took to

stop Defendants’ further violations of the False Claims Act.

423. In acting to stop Defendants’ fraudulent practices, Mr. Spruill

made an effort “to stop 1 or more violations” of the False Claims Act.

424. Mr. Spruill’s actions were protected activity within the meaning

of 31 U.S.C. § 3730(h)(1).

425. Defendants were aware that Mr. Spruill was engaged in protected

activity.

426. Pursuant to 31 U.S.C. § 3730(h)(2), Mr. Spruill is entitled to two

times the amount of back pay, interest on the back pay, and compensation for

any special damages sustained as a result of the discrimination, including

litigation costs and reasonable attorneys’ fees.

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Count XVI
Retaliation in Violation of 6 Del. C. § 1208
against All Defendants
427. Relators re-allege and incorporate by reference the allegations

contained in the preceding paragraphs of this Complaint as if fully set forth

herein.

428. The DFCRA, 6 Del. C. § 1208 provides:

(a) Any employee, contractor, or agent shall be entitled to all

relief necessary to make that employee, contractor, or agent
whole, if that employee, contractor, or agent is discharged,
demoted, suspended, threatened, harassed, or in any other
manner discriminated against in the terms and conditions of
employment because of lawful acts done by the employee,
contractor, agent or associated others in furtherance of an
action under this chapter or other efforts to stop 1 or more
violations of this chapter.
Such relief shall include reinstatement with the same seniority
status that employee, contractor, or agent would have had but
for the discrimination, 2 times the amount of back pay, interest
on the back pay, and compensation for any special damages
sustained as a result of the discrimination, including litigation
costs and reasonable attorneys' fees. . . .
429. Defendants have an obligation under the DFCRA to refrain from

taking any retaliatory actions against employees for attempting to report or

stop fraud pursuant to 6 Del. C. § 1208.

430. Mr. Spruill engaged in protected activity through his efforts to

stop Defendants’ fraudulent practices by, inter alia, voicing his objections to

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his superiors to Defendants’ fraudulent billing practices and the sub-par levels

of care at the Harrington clinic that failed to meet regulatory requirements.

431. Mr. Spruill has been a vocal critic of Defendants’ fraudulent

practices, including by revealing the fraudulent billing practices and the sub-

par levels of care at the Harrington clinic that failed to meet regulatory

requirements.

432. After Mr. Spruill highlighted Defendants’ fraudulent practices

billing practices and the Harrington clinic’s failure to comply with required

regulations, he was discharged, demoted, suspended, threatened, harassed,

and discriminated against in the terms and conditions of his employment

because of the lawful acts he took to stop Defendants’ further violations of the

DFCRA.

433. In acting to stop Defendants’ fraudulent practices, Mr. Spruill

made an effort “to stop 1 or more violations” of the DFCRA.

434. Mr. Spruill’s actions were protected activity within the meaning

of 6 Del. C. § 1208.

435. Defendants were aware that Mr. Spruill was engaged in protected

activity.

436. Pursuant to 6 Del. C. § 1208, Mr. Spruill is entitled to two times

the amount of back pay, interest on the back pay, and compensation for any

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special damages sustained as a result of the discrimination, including litigation

costs and reasonable attorneys' fees.

V. PRAYER FOR RELIEF

WHEREFORE, Relators, Malika Spruill and Douglas Spruill, request

that judgment be entered against the Defendants, ordering that:

437. Defendants cease and desist from violating 31 U.S.C. § 3729;

438. Defendants cease and desist from violating 6 Del. C. § 1201, et

seq.;

439. Defendants pay not less than $11,181 and not more than $22,363,

as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990,

for each violation of 31 U.S.C. § 3729, plus three (3) times the amount of

damages the Government has sustained as a result of Defendants’ actions;

440. Defendants pay not less than $10,957 and not more than $21,916

for each violation of 6 Del. C. § 1201, as adjusted by the Federal Civil

Penalties Inflation Adjustment Act, plus three (3) times the amount of

damages Delaware has sustained as a result of Defendants’ actions;

441. Defendants pay all costs of this action, including attorneys’ fees

and costs pursuant to 31 U.S.C. § 3729(a)(3) and 6 Del. C. § 1201, et seq.;

442. Relators be awarded the maximum “relator’s share” allowed

pursuant to 31 U.S.C. § 3730(d) and 6 Del. C. § 1205;

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443. Ms. Spruill be awarded all relief necessary to make her whole,

including but not limited to, two times her back pay, interest on back pay, and

compensation for any special damages sustained as a result of the

discrimination, including litigation costs and reasonable attorneys’ fees

pursuant to 31 U.S.C. 3730(h);

444. Ms. Spruill be awarded all relief necessary to make her whole,

including but not limited to, reinstatement, two times the amount of back pay,

interest on the back pay, and compensation for any special damages sustained

as a result of the discrimination, including litigation costs and reasonable

attorneys' fees pursuant to 6 Del. C. § 1208;

445. Mr. Spruill be awarded all relief necessary to make him whole,

including but not limited to, two times him back pay, interest on back pay,

and compensation for any special damages sustained as a result of the

discrimination, including litigation costs and reasonable attorneys’ fees

pursuant to 31 U.S.C. 3730(h);

446. Mr. Spruill be awarded all relief necessary to make him whole,

including but not limited to, reinstatement, two times the amount of back pay,

interest on the back pay, and compensation for any special damages sustained

as a result of the discrimination, including litigation costs and reasonable

attorneys’ fees pursuant to 6 Del. C. § 1208;

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447. The Government, Delaware and Relators Malika Spruill and

Douglas Spruill receive such other relief as the Court deems just and proper.

VI. JURY TRIAL DEMANDED

Relators demand trial by a jury of twelve (12).

Dated: June 21, 2019 GRANT & EISENHOFER, P.A.

/s/ Kyle J. McGee

OF COUNSEL: Kyle J. McGee (# 5558)
Laina M. Herbert (# 4717)
123 Justison Street
Brian Mahany (WI 1065623) Wilmington, DE 19801
Tim Granitz (WI 1088934) Tel: 302-622-7000
MahanyLaw KMcGee@gelaw.com
8112 West Bluemound Road LHerbert@gelaw.com
Suite 101
Wauwatosa, WI 53213 Attorneys for Relators Malika
Tel: (414) 258-2375 Spruill and Douglas Spruill
Facsimile: (414) 777-0776
brian@mahanylaw.com
tgranitz@mahanylaw.com

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