A Durango physician is facing a state lawsuit accusing him of billing Colorado's Medicaid program more than $374,000 for addiction treatment services after his clinic's license to provide them had already expired. The Colorado Attorney General's Office alleges Daniel Caplin knew his clinic, Colorado Addiction Treatment Services, had lost its controlled-substance license in June 2022 but kept treating patients and submitting claims to Health First Colorado anyway, continuing through November 2023.
According to the lawsuit, filed in Denver District Court, Caplin owned and operated the Durango clinic, known as CATS, which had been licensed since May 2018 to provide medication-assisted treatment for substance use disorder. As reported by westernslopenow.com, state regulators placed the clinic on a 90-day probationary controlled-substance license in March 2022 following multiple violations. That probationary license expired on June 3, 2022, after the clinic failed to submit a required corrective action plan.
Violations Ranged From Missing Paperwork to Inaccurate Drug Counts
The regulatory violations that triggered the probation included errors in data reporting, inaccurate counts of controlled substance medications, and missing patient consent forms, progress notes and treatment plans, according to seed reporting from The Denver Post. In total, regulators cited the clinic for seven violations in March 2022 before issuing the probationary license that ultimately lapsed that June.
Even after the license expired, the clinic kept operating. On June 17, 2022, a representative from the Colorado Behavioral Health Administration's opioid treatment licensing team visited the facility and notified staff and Caplin directly that the license had expired, the outlet's report notes. Despite that notice, the lawsuit alleges Caplin continued treating patients and billing Health First Colorado for controlled substances he was not licensed to prescribe.
More Than 1,700 Claims Submitted Over 17 Months
From June 2022 through November 2023, CATS submitted 1,704 claims to Health First Colorado totaling $374,240.48, per the same account. That included 703 claims worth $270,664.81 for administering buprenorphine or buprenorphine compounds, along with 1,001 claims totaling $103,575.67 for evaluation and management services tied to substance-use-disorder treatment. The lawsuit alleges state officials were unaware Caplin was unlicensed when they approved the claims.
Caplin voluntarily dissolved Colorado Addiction Treatment Services in December 2023, according to seed facts included in the Denver Post's reporting. The Attorney General's Office is now seeking damages, civil penalties, court costs and attorney fees against him, the article's report states.
Weiser Says Billing Continued Despite Knowledge of Lapse
Attorney General Phil Weiser said Caplin knew his clinic had lost the license needed to provide these services and continued billing Medicaid anyway. Weiser added that providers who accept public funds have a responsibility to follow the law, according to the Colorado Attorney General's Office.
The state filed the civil action under the Colorado Medicaid False Claims Act, which allows for treble damages and additional civil penalties against anyone who knowingly submits false or fraudulent Medicaid reimbursement claims. The lawsuit states that fraud and abuse targeting Medicaid's limited resources prevents the state from providing essential health care services for the most vulnerable Coloradans, a program that is funded jointly by the state and federal government and serves low-income individuals and people with disabilities.
The Durango Herald previously reported on psychiatrist Deborah Parr's suspended medical license, noting that Daniel Caplin ran another practice that received calls from Parr's patients. 9NEWS also covered the allegations, reporting that the 9NEWS case centers on a Colorado doctor accused of billing Medicaid after his license had already expired.
