The AIM Center, a community mental health facility located in Chattanooga, agreed to pay $800,000 to settle allegations that it violated the federal False Claims Act and the Tennessee Medicaid False Claims Act through overcharging for services.
As a result of a joint federal and state investigation, the government alleged in the joint complaint that, from 2009 through 2012, the AIM Center knowingly submitted numerous false claims to the TennCare/Medicaid program by overcharging for psychosocial rehabilitation services provided to TennCare facility members.
Specifically, the government alleges that the AIM Center engaged in a practice commonly known as "upcoding" by submitting claims for services that were more lengthy and more expensive than the services actually provided. For example, the AIM Center submitted claims for a full day (per diem) of PSR services for TennCare/Medicaid members even when the members spent as little as 5 minutes to an hour at the facility.
The government also alleged that the AIM Center knowingly concealed its obligation to return funds to the TennCare/Medicaid program that were improperly paid and retained as a result of "double billing."
"In terms of dollars spent, Medicaid is the federal government's second largest health care program, and it is the single largest payer for mental health services in the United States," said U.S. Attorney Bill Killian in a statement. "Funding for mental health services is an area of significant need for our community. It is critical to the continued viability of our system that providers bill public healthcare programs only as authorized by law. We will continue to aggressively pursue the recovery of funds improperly paid due to fraud, waste or abuse."
The settlement resolves an investigation into AIM's billing practices, which began with the filing of an action by a former member of the facility on under whistle-blower statutes.
For more information, read Wednesday's Times Free Press.