Source: United States Department of Justice Criminal Division
Acadia Healthcare Company Inc., a Delaware corporation with its principal place of business in Franklin, Tennessee, has agreed to resolve allegations that it violated the False Claims Act and related state statutes by knowingly billing for medically unnecessary inpatient behavioral health services or for services that did not meet federal and state regulations. Acadia Healthcare Company owns and operates inpatient behavioral health facilities throughout the United States, including The Pavilion at HealthPark LLC, doing business as Park Royal Hospital in Ft. Myers, Florida; Riverwoods Behavioral Health LLC, doing business as Lakeview Behavioral Health in Norcross, Georgia, and as Riverwoods Behavioral Health System in Riverdale, Georgia; Ten Broeck Tampa LLC, doing business as North Tampa Behavioral Health in Wesley Chapel, Florida; PHC of Michigan LLC, doing business as Harbor Oaks Hospital in New Baltimore, Michigan; and Seven Hills Hospital LLC, doing business as Seven Hills Hospital in Henderson, Nevada (collectively, Acadia).
The United States contended that, between 2014 and 2017, Acadia knowingly submitted false claims for payment to Medicare, Medicaid and TRICARE for inpatient behavioral health services that were not reasonable or medically necessary. In particular, the United States contended that Acadia admitted beneficiaries who were not eligible for inpatient treatment and failed to properly discharge beneficiaries when they no longer needed inpatient treatment and had improper and excessive lengths of stay. The United States further alleged that Acadia knowingly failed to provide adequate staffing, training and/or supervision of staff, which resulted in assaults, elopements, suicides and other harm resulting from these staffing failures. In addition, Acadia allegedly failed to provide inpatient acute care in accord with federal and state regulations, including, but not limited to, by failing to provide active treatment, to develop and/or update individualized assessments and treatment plans, to provide adequate discharge planning and to provide required individual and group therapy.
Under the settlement agreement, Acadia will pay $16,663,918 to the United States to resolve its liability under the False Claims Act for its allegedly false Medicare, Medicaid and TRICARE billings. The Medicaid program is jointly funded by the states and the federal government, and pursuant to separate settlement agreements, Acadia will pay an additional $3,186,082 to Florida, Georgia, Michigan and Nevada to resolve their state law claims against Acadia.
“This settlement demonstrates the Justice Department’s commitment to ensuring that federal healthcare programs pay only for services that are needed and properly provided,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “It is particularly important that health care providers satisfy these requirements when providing services to a vulnerable patient population, such as residents of an inpatient behavioral health facility.”
“Federal health care programs rely upon the honesty and credibility of participating providers,” said U.S. Attorney Roger B. Handberg for the Middle District of Florida. “The Justice Department will hold accountable those who seek to exploit these programs for personal gain, jeopardizing the health of patients.”
“Medical providers who participate in federally funded health care programs must follow the law when billing Medicare, Medicaid and Tricare,” said Special Agent in Charge Tamala E. Miles of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “This settlement illustrates HHS-OIG’s commitment to protecting the integrity of these taxpayer-funded programs and the well-being of enrollees seeking treatment. Working closely with the United States Attorney’s Office and other law enforcement partners, we will continue to thoroughly investigate such fraudulent billing schemes.”
“Billing TRICARE for medically unnecessary inpatient behavioral health services or for services that did not meet federal and state regulations impacts our ability to reimburse providers in a timely manner for care that is needed to keep our military ready to defend the nation,” said Rear Admiral Matthew Case of the U.S. Navy and Acting Assistant Director for Health Care Administration for the Defense Health Agency. “We thank our state and federal partners for their work on this case, and the whistleblowers who came forward for their bravery. As a result, we are able to continue delivering one of the most comprehensive and affordable health benefits available to any American.”
The settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Franka Tirado, Brian Snyder and Jamie Thompson, all former employees of Acadia. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam cases are captioned U.S. ex rel. Tirado, et al. v. Park Royal Hospital et al., Case No. 2:17-cv-201-FtM-99 (MDFL), and U.S. ex rel. Thompson v. Acadia Healthcare Company Inc., et al., Case No. 2:18-cv-543-FtM-38CM (MDFL). The whistleblower share of the federal portion of the settlement will be $3,166,144.42.
The resolution obtained in this matter was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section, and U.S. Attorney’s Office for the Middle District of Florida, as well as the National Association of Medicaid Fraud Control Units, with assistance from HHS-OIG and the Department of Defense Criminal Investigative Service.
The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to HHS at 800-HHS-TIPS (800-447-8477).
Senior Trial Counsel Sarah Arni of the Civil Division’s Fraud Section and former Senior Litigation Counsel Lindsay Griffin for the Middle District of Florida handled the matter.
The claims resolved by the settlements are allegations only. There has been no determination of liability.