Oglethorpe Inc. and its three Ohio facilities, Cambridge Behavioral Hospital, Ridgeview Behavioral Hospital, and The Woods at Parkside, will pay $10.25 million to resolve alleged violations of the False Claims Act for improperly providing free long-distance transportation to patients and admitting patients at Cambridge and Ridgeview who did not require inpatient psychiatric treatment, resulting in the submission of false claims to the Medicare program.
Oglethorpe Inc. is a Florida company that operates two Ohio inpatient psychiatric hospitals, Cambridge and Ridgeview, and one Ohio substance abuse treatment facility, Parkside. The settlement was based on analysis of the companies’ ability to pay after review of their financial condition.
This settlement resolves allegations that, between August 2013 and June 2019, defendants provided free long-distance van transportation to patients to induce them to seek treatment at the defendants’ facilities, in violation of the Anti-Kickback Statute, and then submitted claims for services provided to these patients, in violation of the False Claims Act. The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by a federal health care program, such as Medicare, Medicaid or TRICARE. Claims submitted to these programs in violation of the Anti-Kickback Statute give rise to liability under the False Claims Act. The government also alleged that Oglethorpe, Cambridge, and Ridgeview submitted, or caused to be submitted, false claims to Medicare for medically unnecessary inpatient psychiatric admissions and associated services at the two hospitals.
“Kickbacks to patients can result in unnecessary services that serve neither the patients nor our federal health care programs,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “The Justice Department is committed to pursuing unlawful remunerations in whatever form they occur to safeguard taxpayer funded health care benefits.”
“Submitting false claims by billing for unnecessary inpatient psychiatric hospitalizations is not only inappropriate – it’s illegal,” said Acting U.S. Attorney Vipal J. Patel for the Southern District of Ohio. “This settlement shows that the United States will hold accountable those who seek to profit by flouting proper standards of medical practice and appropriate review and submission of Medicare billings.”
“Kickbacks in the form of free van rides and the false claims subsequently submitted to federal health care programs come at a tremendous cost to patients and the taxpayers,” said Special Agent in Charge Lamont Pugh for the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG). “We will continue to work with our law enforcement partners to pursue and hold accountable entities who engage in such acts.”
Contemporaneous with the settlement, Oglethorpe entered into a corporate integrity agreement (CIA) with HHS-OIG. Among other things, the CIA requires that for the next five years Oglethorpe must retain an Independent Review Organization to review its claims to Medicare and Medicaid.
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Darlene Baker, a former client advocate at Cambridge. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery if the government takes over the case and reaches a monetary agreement with the defendant. The qui tam case is captioned United States ex rel. Baker v. Oglethorpe, Inc., et al., No. 2:16-cv-1040 (S.D. Ohio).
The resolutions obtained in this matter were the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section; the U.S. Attorney’s Office for the Southern District of Ohio; and HHS-OIG.
The matter was investigated by Trial Attorney Christopher Wilson of the Civil Division and Assistant U.S. Attorney Andrew Malek.
The claims resolved by the settlement are allegations only and there has been no determination of liability.