Simi Valley (Calif.) Hospital and Health Care Services agreed to pay the U.S. $5.2 million to settle a whistle-blower lawsuit alleging the hospital's behavioral-health unit submitted improper claims to Medicare and Medicaid in the 1990s.
The 137-bed hospital, which is part of Adventist Health, a 19-hospital system based in Roseville, Calif., did not admit any wrongdoing by entering the settlement. “We believe that our hospital follows fair and accurate billing practices and are settling to avoid the expense and inconvenience of lengthy litigation,” the hospital said in a written statement.
The lawsuit was filed under the False Claims Act in 2001 by Timothy Field, a physician who was program director and then administrative director for behavioral medicine from 1993 to 2000. He alleges in the complaint that he was terminated for questioning the billing practices.
The allegations include that the hospital billed the government programs for psychiatric care when patients in fact received treatment for drug and alcohol dependency; admitted patients overnight who didn't meet criteria for hospitalization; and paid a medical director $12,000 a month to establish and admit patients into a nonexistent program for women with post-traumatic stress disorder.
The U.S. Justice Department formally joined the lawsuit in October, noting in its court filing that the intervention was “for the purpose of effectuating a settlement.”
