WASHINGTON D.C. – The federal government announced Thursday that 16 hospitals will pay a total of $15.6 million to resolve allegations that the hospitals and their corporate owners billed Medicare for medically unnecessary psychotherapy services, officials said.The act allows private individuals to sue on behalf of the United States and to share in the proceeds of any settlement or judgment that may result.
The whistleblower in this case will receive $2.6 million.
“Hospitals that participate in the Medicare program must ensure that the services they provide and bill for are based on the medical needs of patients rather than the desire to maximize profits,” said Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division. “The Department of Justice is committed to ensuring that those who seek to abuse the Medicare program will be held accountable for their actions.”
The hospitals who reached agreements include Health Management Associates Inc. and the following 14 hospitals formerly owned and operated by Management Associates.
- Community Health Systems and its subsidiary Wesley Medical Center in Mississippi, which agreed to pay $210,000
- North Texas Medical Center in Texas, which agreed to pay $480,000.
The Medicare allegations started in 2005 and up until 2013. Officials said the hospitals submitted false claims for Intensive Outpatient Psychotherapy services that didn’t qualify for Medicare reimbursement.
This was for several reasons:
- The patient’s condition did not qualify for outpatient psychotherapy
- The patient’s treatments were not provided as part of a treatment plan
- The patient’s progress was not being adequately tracked or documented
- The patient received an inappropriate level of treatment
- The therapy provided was primarily recreational or diversional in nature, and not therapeutic.