Acadia Healthcare Company, Inc., has reached a settlement agreement with the United States Department of Justice (DOJ) to resolve allegations that it violated the False Claims Act and certain state statutes by knowingly billing for medically unnecessary inpatient behavioral health services, or for services that did not meet federal and state regulations. Acadia owns and operates inpatient behavioral health facilities throughout the United States.
The United States alleged that from 2014 to 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. Specifically, Acadia allegedly admitted beneficiaries who were not eligible for inpatient treatment and failed to properly discharge patients when they no longer needed inpatient treatment, resulting in inappropriate lengths of stay.
Acadia further allegedly knowingly failed to provide adequate staffing, training, and/or supervision of staff, which resulted in assaults, elopements, suicides, and other harm. Acadia also allegedly failed to provide inpatient acute care in accord with federal and state regulations, including failing to provide active treatment, failing to develop and/or update individualized assessments and treatment plans, failing to provide adequate discharge planning, and failing to provide required individual and group therapy.
Acadia will pay $16,663,918 to the United States to resolve liability under the federal False Claims Act and an additional $3,186,082 to Florida, Georgia, Michigan, and Nevada, to resolve state law claims. The claims were originally brought under the qui tam provisions of the False Claims Act by former employees of Acadia. The whistleblowers will receive $3,166,144.42 from the federal portion of the settlement for their role.
“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.”
In a separate, but possibly related matter, Acadia released a statement regarding a recent government investigation into the company following complaints made by patients at Acadia facilities. “Ensuring we provide the highest quality of care is personal for me and the number one priority for my colleagues across the Company,” said Acadia Chief Executive Officer Chris Hunter. “We take seriously our patient care and compliance responsibilities and understand how critical it is to provide these services with excellence and compassion. We’re committed to taking action on incidents that fall short of our rigorous standards and are making investments necessary to establish Acadia as the leading behavioral healthcare provider for high-acuity and complex needs patients.”