Acadia Healthcare Company Inc., a corporation established in Delaware and headquartered in Franklin, Tennessee, has consented to settle claims asserting that it breached the False Claims Act and associated state laws by willfully submitting bills for inpatient behavioral health services that were not medically necessary or for services that failed to comply with federal and state regulations.
The United States asserted that from 2014 to 2017, Acadia intentionally submitted fraudulent claims for reimbursement to Medicare, Medicaid, and TRICARE for inpatient behavioral health services that were neither reasonable nor medically necessary.
Specifically, the United States claimed that Acadia admitted patients who were ineligible for inpatient care and did not appropriately discharge patients when they no longer required such treatment, resulting in improper and excessive lengths of stay. Additionally, the United States alleged that Acadia knowingly failed to ensure adequate staffing, training, and supervision of its personnel, leading to incidents of assaults, elopements, suicides, and other adverse outcomes stemming from these staffing deficiencies.
Furthermore, Acadia was accused of not providing inpatient acute care in compliance with federal and state regulations, which included failing to deliver active treatment, develop or update individualized assessments and treatment plans, ensure adequate discharge planning, and provide necessary individual and group therapy. As part of the settlement agreement, Acadia will pay $16,663,918 to the United States to address its liabilities under the False Claims Act related to the alleged fraudulent billings to Medicare, Medicaid, and TRICARE.
The Medicaid program is co-funded by state and federal governments, and under separate settlement agreements, Acadia will also pay an additional $3,186,082 to the states of Florida, Georgia, Michigan, and Nevada to resolve their respective state law claims against the company.
“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.”