Eagleville Hospital, a provider of substance abuse treatments to beneficiaries of Medicare and Medicaid, has reached a $2.85 million settlement with the government to resolve allegations that it defrauded various federal health care programs. According to a False Claims Act lawsuit filed by a whistleblower, the hospital billed Medicaid, Medicare, and the Federal Employees Health Benefits Program for detoxification treatments for ineligible patients.
The anonymous whistleblower has been awarded $500,000 for his key role in the recovery of millions of taxpayer dollars. Under the False Claims Act, individuals with information about fraud can file a complaint while protected by anti-retaliation provisions, receiving between 15 and 30 percent of any resulting recoveries.
According to the complaint that originated the settlement, Eagleville Hospital systematically admitted various categories of patients to secure the highest reimbursement class of detoxification treatments, when there was no medical necessity for it. As a consequence, the hospital submitted false claims to the government in its billing for these services. The alleged misconduct took place between January 2011 and December 2018.
Besides the monetary settlement, Eagleville has agreed to enter into a Corporate Integrity Agreement for a period of five years. For the duration of the Agreement, the hospital’s billing to federal programs will be closely monitored by the Department of Health and Human Services. The hospital will be required to implement risk assessment processes, related training, and audits.
In a statement, First Assistant U.S. Attorney Jennifer Arbittier Williams referred to Eagleville’s alleged misconduct in connection with the opioid crisis. “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,” she commented. Arbittier Williams also highlighted the importance of the Corporate Integrity Agreement and commended the whistleblower for “bringing this matter to our attention,” and allowing prosecutors to “preserve the integrity of federal healthcare and opioid use disorder treatment programs.”
Special Agent Maureen R. Dixon of the Department of Health and Human Services emphasized the importance of whistleblowers coming forward to expose fraudsters. “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,” she concluded.