Corporate Compliance

CA hospital settles Medicare fraud case for $5.1M

Compliance Monitor, November 10, 2010

Simi Valley (CA) Hospital paid the United States $5.1 million to resolve allegations that its behavioral medicine services unit knowingly submitted false claims to Medicare for chemical dependency and psychiatric patient services performed between 1991 and 1997, according to a Department of Justice (DOJ) press release.

Timothy Field, former program director, and then the administrative director, for Simi Valley Hospital’s behavioral medicine services unit, filed the case under the qui tam provision of the federal False Claims Act.

Field alleged that Simi Valley Hospital improperly billed Medicare and the California Medicaid program for:

  • Psychiatric care, even though the patients were receiving chemical dependency detoxification services
  • Psychiatric overnight stays and inpatient services, even though the patients did not meet the criteria for inpatient hospitalization
  • A medical director’s salary of $12,000 per month to establish, and to get patients admitted into, a non-existent program for women dealing with post-traumatic stress disorder

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