- The Department of Justice announced Thursday that 16 hospitals will pay a total of $15.69 million to resolve allegations that they billed Medicare for unnecessary mental health services.
- $15 million will come from Health Management Associates and 14 of its formerly-associated hospitals. Health Management Associates is now owned by Community Health Systems, which acquired its smaller rival for $3.9 billion in 2014.
- Community Health Systems and its subsidiary Wesley Medical Center (Mississippi) will pay $210,000; and North Texas Medical Center will pay $480,000.
The disputed claims cover a period between 2003 and 2013. According to the DOJ release, the providers knowingly billed for unnecessary treatments that did not meet Medicare's reimbursement standards and provided substandard therapy:
"These settlements resolve allegations that, beginning as early as 2005 and in some cases continuing into 2013, the hospitals knowingly submitted claims for IOP services that did not qualify for Medicare reimbursement because: the patient's condition did not qualify for IOP; the patient’s treatments were not provided pursuant to an individualized treatment plan designed to help the patient address specific mental health needs and reach achievable goals; the patient's progress was not being adequately tracked or documented; the patient received an inappropriate level of treatment; and/or the therapy provided was primarily recreational or diversional in nature, and not therapeutic," the release said.
The companies have not admitted any liability under the terms of the settlement and have not yet commented on the agreement.