Wednesday, November 20, 2019

Hospital Slapped with $2.85m Fine for Shady Detox Billing

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United States Attorney William McSwain announced today that Eagleville Hospital, which provides substance use disorder treatment in Eagleville, Pennsylvania, has agreed to pay $2.85 million to the federal government to resolve allegations that the hospital violated the False Claims Act by submitting claims to Medicare, Medicaid, and the Federal Employees Health Benefits Program (“FEHBP”) for hospital-level detoxification treatment services when the patients were ineligible for admission to receive such services or lacked documentation to support the claims.

The settlement resolves allegations in a complaint filed in federal court in the Eastern District of Pennsylvania by a whistleblower under the qui tam provisions of the False Claims Act. These provisions allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The whistleblower here will receive over $500,000 of the recovery. He was represented by David Caputo of Youman & Caputo and Joseph Trautwein of Joseph Trautwein & Associates.

Contemporaneous with the civil settlement, Eagleville Hospital also entered into a five-year Corporate Integrity Agreement (“CIA”) with the Department of Health and Human Services, Office of Inspector General (“HHS-OIG”), which requires, among other things, the implementation of a risk assessment and internal review process designed to identify and address evolving compliance risks on an ongoing basis. The CIA requires training, auditing, and monitoring designed to address the conduct at issue in the case.

In his qui tam complaint, the whistleblower alleged that Eagleville Hospital admitted certain groups of its substance use disorder treatment patients for the higher-reimbursing hospital-level detoxification treatment, rather than the residential-level treatment, without satisfying the medical necessity requirements to do so. The whistleblower alleged that this practice resulted in false claims to Medicare, Medicaid, and FEHBP. This settlement agreement resolves the allegations for claims from January 2011 through December 2018.

“As our country and communities struggle with the burdens of opioid use disorder, it is critical that we protect federal healthcare programs serving individuals with those disorders and ensure that detoxification treatment providers like Eagleville Hospital are appropriately billing for the necessary services provided to their patients,” said First Assistant U.S. Attorney Jennifer Arbittier Williams. “We appreciate Eagleville Hospital’s willingness to negotiate a prompt resolution in this matter, including entering a Corporate Integrity Agreement to address compliance going forward. We also thank the whistleblower for bringing this matter to our attention. Together with his lawyers, this whistleblower allowed us to pursue this investigation and preserve the integrity of federal healthcare and opioid use disorder treatment programs.”

“We thank the whistleblower for bringing this conduct to our attention and also thank Eagleville Hospital for their assistance in resolving the matter,” said Maureen R. Dixon, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “We encourage individuals and companies to work together with HHS-OIG and the U.S. Attorney’s to ensure federally funded healthcare resources are used appropriately.”

There has been no determination of civil liability. The settled civil claims are allegations only.

This case was handled by Assistant United States Attorney Anthony D. Scicchitano with investigative assistance from auditor Dawn Wiggins, HHS-OIG, and the Office of Personnel Management Office of Inspector General.

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