Acadia Healthcare Company has agreed to pay $17 million to resolve allegations that it defrauded Medicaid out of $8.5 million. This is the largest settlement ever reached in a case of Medicaid fraud in West Virginia.
U.S. Attorney Mike Stuart emphasized the significance of an $8.5-million fraud for West Virginia’s Medicaid beneficiaries. “Medicaid fraud is not a victimless crime,” he said. “I am proud of the work of my office and that of our partners to ensure the end of this multi-million dollar scheme . . . The message is clear – if you are cheating the system and we find you, you’ll not only pay for the damage done but far more. This is a message of deterrence to other would-be fraudsters,” Stuart concluded.
Acadia operates several treatment centers across West Virginia, in Charleston, Huntington, Parkersburg, Beckley, Williamson, Clarksburg, and Wheeling. The centers were authorized to perform low complexity tests covered by Medicaid and Medicare. Prosecutors found that Acadia did, however, send urine and blood samples taken at the centers to another laboratory, which then billed Acadia for high-complexity tests.
The defendant later billed Medicaid more than it had paid for the tests, misrepresenting to the government program that the tests had been carried out at its own medical centers rather than at an external lab. The reported misconduct took place between early 2012 and July 2018.
As a result of Acadia’s improper billing, Medicaid paid the company $8.5 million. The government considered the $17 million settlement a fitting cautionary tale for would-be fraudsters. Additionally, Acadia and CRC Health, a subsidiary instrumental in the scheme, have agreed to enter into a corporate integrity agreement (“CIA”) to prevent future misconduct and inappropriate billing. The CIA will initially last five years.
With Medicaid fraud growing every year, and providers routinely billing government health programs for unnecessary services, and overbilling for necessary ones, this type of settlements and fraud investigations are key to try to keep fraudsters at bay. Last year, U.S. taxpayers lost a staggering $40 billion to healthcare fraud.
Because the treatment centers controlled by Acadia are dedicated to administering methadone, the DEA was one of the agencies involved in the fraud investigation. Regarding its participation, a spokesperson commented, “The Drug Enforcement Administration routinely works in partnership with other agencies to fight the opioid crisis. This settlement is just one example of the great results from our collaboration and hopefully, it will have a positive effect on the people of West Virginia.”
For the Department of Health and Human Services’ OIG Special Agent Maureen R. Dixon, “Fraudulent billing by these Acadia/CRC drug treatment clinics . . . limits [West Virginia’s] ability to provide desperately needed addiction treatment services.”
Dixon said her office and its partners will continue to “protect government health programs, taxpayers, and importantly people who depend on these funds for vitally needed treatment.”
Under the U.S. and state False Claims Acts, whistleblowers that report healthcare fraud involving Medicaid or Medicare could be entitled to a percentage of any verdict or settlement. Report fraud today, and you might earn a multimillion-dollar reward - hundreds of whistleblowers have already received rewards.