Eagleville Hospital Pays $2.85 Million to Resolve Allegations of Improper Billing for Detox Treatmen
PHILADELPHIA – 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.
Read more: https://www.justice.gov/usao-edpa/pr/eagleville-hospital-pays-285-million-resolve-allegations-improper-billing-detox