Center, Inc. (AIM), which operates a community mental health facility located
in Chattanooga, Tenn., has agreed to pay $800,000 to settle allegations that it
violated the federal False Claims Act (FCA) and the Tennessee Medicaid False
Claims Act (TNMFCA).
This settlement resolves an investigation into AIM's
billing practices which began with the filing of an action by a former member
of the facility on behalf of the United States and the State of Tennessee under
the qui tam, also known as whistle-blower, provisions of both the FCA
and the TNMFCA. The United States and the State of Tennessee subsequently
filed a joint intervention complaint.
As a result
of a joint federal and state investigation, the government alleged in the joint
complaint that, from 2009 through 2012, the AIM Center knowingly submitted
numerous false claims to the TennCare/Medicaid program by overcharging for
psychosocial rehabilitation (PSR) services provided to TennCare/Medicaid
Specifically, the government alleged that the AIM Center
engaged in a practice commonly known as "upcoding" by submitting claims for
services that were more lengthy and more expensive than the services actually
provided. For example, the AIM Center submitted claims for a full day (per
diem) of PSR services for TennCare/Medicaid members even when the
members spent as little as 5 minutes to an hour at the facility.
addition, the government alleged that the AIM Center knowingly concealed its
obligation to return funds to the TennCare/Medicaid program that were improperly
paid and retained as a result of "double billing" (submitting distinct and
separate claims for services that were already included in the scope of the per
made by the AIM Center in connection with this settlement is intended to
compensate the TennCare/Medicaid program for monies paid out of that program
which the AIM Center improperly received.
As part of the overall
settlement, the AIM Center has also entered into a comprehensive 5-year
Corporate Integrity Agreement (CIA) with the U.S. Department of Health and
Human Services, Office of Inspector General (HHS-OIG) to ensure its future
compliance with federal health care benefit program requirements.
behavioral health services are a vital component of the care provided to
TennCare recipients. "This Office
will continue to pursue providers that improperly bill for these needed
services," said Tennessee Attorney General Bob Cooper.
of dollars spent, Medicaid is the federal government's second largest health
care program,and it is the single largest payer for mental health
services in the United States," said U.S. Attorney Bill Killian. "Funding
for mental health services is an area of significant need for our
community. It is critical to the continued viability of our system that
providers bill public healthcare programs only as authorized by law. We
will continue to aggressively pursue the recovery of funds improperly paid due
to fraud, waste or abuse."