A Colorado doctor fraudulently billed the state’s Medicaid program nearly $375,000 after his clinic lost its license to provide opioid addiction treatment services in 2022, a new lawsuit alleges.
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For more than a year, Durango physician Daniel Caplin billed Health First Colorado, the state’s Medicaid program, for controlled substances he was not licensed to prescribe, according to the lawsuit filed earlier this month in Denver District Court.
Caplin owned and operated Colorado Addiction Treatment Services in Durango, where state regulators found seven violations in March 2022, the lawsuit stated. Violations included errors in data reporting; missing records, including patient consent forms, progress notes and treatment plans; and inaccurate counts of controlled substance medications, according to the lawsuit.
The clinic was placed on a 90-day probation and, when it failed to submit the required corrective action plan, lost its license in June 2022, according to the lawsuit. It was first licensed in May 2018.
But Caplin continued to treat patients and bill Health First Colorado after the clinic’s license expired, according to the lawsuit. Between June 2022 and November 2023, his clinic submitted 1,704 claims to the program totaling $374,240, the lawsuit alleges. Caplin “voluntarily dissolved” the clinic in December 2023.
State officials approving the claims were unaware that Caplin was unlicensed, the lawsuit alleges.
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Colorado’s Medicaid program is funded by the state and federal government to provide health care to low-income individuals and people with disabilities.
“Fraud and abuse targeting Medicaid’s limited resources … prevents the State from providing essential healthcare services for the most vulnerable Coloradans,” the lawsuit stated.
A person who knowingly submits false or fraudulent claims for reimbursement can be liable for up to three times the amount and additional civil penalties under the Colorado Medicaid False Claims Act, according to the Colorado Attorney General’s Office.
“We allege that Dr. Caplin knew his clinic had lost the license needed to provide these services and continued billing Medicaid anyway,” Attorney General Phil Weiser said in a statement. “Providers who accept public funds have a responsibility to follow the law, and we will hold accountable those who defraud Colorado taxpayers.”
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