A settlement has been reached to resolve False Claims Act allegations against Allegiance Health Management Inc.
The allegations arose from a lawsuit that claimed Allegiance Health Management Inc (Allegiance) and four hospitals owned and operated by Allegiance submitted and caused other hospitals to submit claims for reimbursement from Medicare for services that were not medically reasonable or necessary.
According to the government, beginning in 2005, Allegiance allegedly cut deals with hospitals to provide Intensive Outpatient Psychotherapy services to patients on the hospitals' behalf.
Reportedly, Allegiance established an Inspirations Outpatient Counseling Center, where Allegiance employees identify potential patients, created patient treatment plans, and performed IOP services at these hospitals.
This settlement resolves claims that Allegiance provided IOP services to Medicare patients that did not qualify reimbursement because:
- The patients' medical conditions did not require IOP treatment;
- The patients' treatments were not consistent with an individualized treatment plan designed to address specific mental health needs and achievable goals;
- The patients' progress was not being tracked or documented;
- The patients received inappropriate levels of treatment;
- The therapy provided was primarily recreational or diversional, not therapeutic.
“Medicare funds must be targeted to those with a legitimate need,” said Special Agent in Charge CJ Porter for the Office of Inspector General of the U.S. Department of Health and Human Services. “Entities that bill for needless services – as alleged here – cheat taxpayers and threaten the integrity of government health programs.”
The whistleblowers, Ryan Ladner, a former employee of Allegiance, share of the settlement will be approximately $300,000.
