Thanks again for the massive outpouring of support for this ³newsletter² of sorts.
Our goal is simple: To find and share relevant newsworthy information related to the treatment industry in order to better educate and advise stakeholders and other interested persons about the economy of, and public policy behind, behavioral health care.
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Now, onto today¹s News Update.
CRC Health Group, Inc., one of the largest (if not the largest) treatment provider in the U.S., itself got caught up in what is referred to as a ³Qui Tam² or ³Whistleblower² suit. This is when a private individual is authorized to bring a private lawsuit on behalf of the state or U.S. Government to enforce the various anti-kickback and fraud statutes governing the provision of health care services and compensation. The private individual get a ³piece² of the recovery, which can be in the hundreds of thousands, if not millions, of dollars. It¹s like ³deputizing² everyone out there and incentivizing them to ³blow the whistle² on law violators by – you guessed it – giving them a kickback of whatever proceeds are obtained through settlement or judgment.
From our friends over at 360Law.com:
“New Life Lodge accepted millions of dollars of TennCare funds with the understanding that it would provide necessary substance abuse treatment services to some of the state’s most vulnerable citizens,” Cooper stated in response to the settlement. “Instead, far too often, those operating the facility failed to meet their obligations by falling short of minimum necessary standards of care or using third-party pharmacies to double-bill the program.”
In addition, CRC allegedly hired unlicensed personnel and failed to adequately supervise them, billed for undocumented services and didn’t meet several of the Medicaid program’s “medical necessity” requirements. The qui tam allegations also claimed that CRC didn’t follow its own patient treatment plans or give patients access to a psychiatrist, which is required under law.
Tennessee and federal authorities first got wind of CRC’s alleged Medicaid violations when a former employee, Angela Cederoth, filed a whistleblower suit on behalf of the state and United States. She will receive a portion of the recovered funds for her qui tam involvement.