Acadia Healthcare Company Inc., a major operator of inpatient behavioral health facilities across the United States, has agreed to pay $16.6 million to settle allegations that it violated the False Claims Act by improperly billing Medicare, Medicaid, and TRICARE for services that were not medically necessary or did not meet federal and state regulations. In addition to the federal settlement, Acadia will pay $3.18 million to settle claims brought by Florida, Georgia, Michigan, and Nevada for violations of state statutes.

The U.S. Department of Justice (DOJ) contended that, between 2014 and 2017, Acadia submitted false claims for behavioral health services that were either unnecessary or inappropriately prolonged. The company allegedly admitted patients who didn’t qualify for inpatient care and kept patients longer than necessary, violating patient care standards. Acadia also failed to provide adequate staffing, supervision, and treatment plans, resulting in patient harm, including assaults and elopements.

“Federal health care programs rely upon the honesty and credibility of participating providers,” said U.S. Attorney Roger B. Handberg for the Middle District of Florida. “The Justice Department will hold accountable those who seek to exploit these programs for personal gain, jeopardizing the health of patients.”

As part of the settlement, Acadia also resolves claims related to the failure to provide adequate discharge planning and required therapy. The whistleblowers in this case, Franka Tirado, Brian Snyder, and Jamie Thompson, former Acadia employees, will share in a $3.16 million portion of the federal settlement under the qui tam provisions of the False Claims Act.

The False Claims Act (FCA), originally enacted in 1863, is one of the most powerful tools used by the U.S. government to combat fraud against federal programs, particularly in the healthcare sector. It allows the government to pursue individuals or entities that knowingly submit false or fraudulent claims for payment to federal programs like Medicare, Medicaid, and TRICARE.

In the Acadia Healthcare case, the government alleged that between 2014 and 2017, Acadia violated the FCA by submitting false claims for behavioral health services that were either medically unnecessary or did not meet federal and state requirements. Specifically, the company was accused of billing for services provided to patients who were not eligible for inpatient care and extending stays longer than necessary, thus inflating claims for reimbursement from federal programs.

Under the FCA, whistleblowers—known as relators—can file lawsuits on behalf of the government under the qui tam provision, as Franka Tirado, Brian Snyder, and Jamie Thompson did in this case. These whistleblowers are entitled to a share of the recovery, which in Acadia's case amounted to $3.16 million of the federal settlement. The FCA imposes significant penalties, including treble damages (three times the actual damages) and additional fines for each false claim submitted.