AIM Center Pays $800,000 To Settle Billing Dispute With State And Federal Governments

Tuesday, February 18, 2014

The AIM Center, Inc.,  which operates a community mental health facility in Chattanooga, has agreed to pay $800,000 to settle allegations that it violated the federal False Claims Act (FCA) and the Tennessee Medicaid False Claims Act (TNMFCA). 

This settlement resolves an investigation into AIM’s billing practices which began with the filing of an action by a former member of the facility on behalf of the United States and the State of Tennessee under the qui tam, also known as whistle-blower, provisions of both the FCA and the TNMFCA.  The United States and the State of Tennessee subsequently filed a joint intervention complaint.

As a result of a joint federal and state investigation, the government alleged in the joint complaint that, from 2009 through 2012, the AIM Center knowingly submitted numerous false claims to the TennCare/Medicaid program by overcharging for psychosocial rehabilitation (PSR) services provided to TennCare/Medicaid facility members.  Specifically, the government alleged that the AIM Center engaged in a practice commonly known as “upcoding” by submitting claims for services that were more lengthy and more expensive than the services actually provided.  For example, the AIM Center submitted claims for a full day (per diem) of PSR services for TennCare/Medicaid members even when the members  spent as little as 5 minutes to an hour at the facility.

In addition, the government alleged that the AIM Center knowingly concealed its obligation to return funds to the TennCare/Medicaid program that were improperly paid and retained as a result of “double billing” (submitting distinct and separate claims for services that were already included in the scope of the per diem services).  

The payment made by the AIM Center in connection with this settlement is intended to compensate the TennCare/Medicaid program for monies paid out of that program which the AIM Center improperly received.  As part of the overall settlement, the AIM Center has also entered into a comprehensive 5-year Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) to ensure its future compliance with federal health care benefit program requirements.

“Mental and behavioral health services are a vital component of the care provided to TennCare recipients,” Tennessee Attorney General Bob Cooper said. “This Office will continue to pursue providers that improperly bill for these needed services.”

“In terms of dollars spent, Medicaid is the federal government’s second largest health care program, and it is the single largest payer for mental health services in the United States,” said U.S. Attorney Bill Killian.  “Funding for mental health services is an area of significant need for our community.  It is critical to the continued viability of our system that providers bill public healthcare programs only as authorized by law.  We will continue to aggressively pursue the recovery of funds improperly paid due to fraud, waste or abuse.”

The investigative team whose efforts resulted in this settlement was comprised of representatives from the Tennessee Bureau of Investigation (TBI), the Tennessee Attorney General’s Office, the U.S. Department of Health and Human Services Office of Inspector General, and the U.S. Attorney’s Office.  Tennessee Attorney General Bob Cooper commended the cooperative efforts of the agencies who participated in the investigation.

AIM issued this statement, "Earlier this week The AIM Center finalized an agreement with the state of Tennessee and the federal government related to a civil claim regarding billing for psychosocial services provided to TennCare-covered individuals. None of the funds to resolve the dispute come from donor contributions or grants awarded to The AIM Center.

"Although it is AIM’s position that their billings to TennCare were proper according to AIM’s contract with the state, AIM made the decision to settle the civil claims with the government to avoid an expensive and distracting legal battle in court. Services provided by the AIM Center were never interrupted or will be limited as a result of the agreement. The government did not claim The AIM Center failed to provide services to their members or that the services provided were unnecessary. The AIM Center continues to thrive and serve individuals with mental illness in our community by providing education, life skill development, employment services and support to live healthy, fulfilling lives."

Since opening in April, 1989, AIM Center has provided services using the Clubhouse Model of Psychosocial Rehabilitation.  The clubhouse model is described as "a comprehensive and dynamic program of support and opportunities for people with severe and persistent mental illnesses.  Unlike day-treatment programs, clubhouse participants are 'members' who work collaboratively with staff on restorative activities that develop members’ strengths and abilities.  The clubhouse model is unique and the services provided are unlike those of traditional healthcare providers.  AIM Center has been nationally recognized for its excellence in delivering such services."


CHI Memorial Awarded Advanced Certification for Primary Stroke Centers

CHI Memorial has earned The Joint Commission’s Gold Seal of Approval and the American Heart Association/American Stroke Association’s Heart-Check mark for Advanced Certification for Primary Stroke Centers. The Gold Seal of Approval and the Heart-Check mark represent symbols of quality from their respective organizations.  CHI Memorial underwent a rigorous onsite review ... (click for more)

Assisted Living Locators Launches Newest Office In Chattanooga

Assisted Living Locators announce the launch of its Assisted Living Locators franchise in Chattanooga.  Assisted Living Locators provides a free, community-oriented, hands-on assistance in locating quality assisted living options in the Southeast Tennessee and Northern Georgia area.The franchise is owned by John R. Rouser, an Assisted Living Locators Elder Care advisor. ... (click for more)

Circuit Court Jury Gives $20,599,000 Verdict In Favor Of Canyon Ridge Developers; Punitive Damages To Be Added

A Hamilton County Circuit Court jury on Thursday awarded $20,599,000 to the developers of Canyon Ridge on Lookout Mountain against a financial firm that allegedly secretly started working on a rival project. The jury also said the plaintiffs are due punitive damages. The amount will be set on Monday morning in the courtroom of Judge J.B. Bennett after each side gives 20-minute ... (click for more)

East Ridge To Have Saturday Session To Deal With Important Issues; Denny Manning Says He Will Take On Marc Gravitt For State House

Because one of the members was absent from the East Ridge City Council meeting Thursday night, discussions of several important issues that were on the agenda were postponed. The meeting was recessed and will continue on Saturday at 9 a.m. when everyone can be present to consider the city manager’s contract, employee’s insurance, a variance request for a beer permit, a contract ... (click for more)

Erlanger Electronic Medical Records Purchase Doesn't Add Up

Erlanger has recently announced their decision to purchase a $100,000,000 Electronic Health Information System. Something smells. Erlanger's downtown campus has 760 licensed beds, according to hospital-data. That would equate to $131,578 per bed for this system (now that's a lot of ipads). Please re-read that simple math. I use to manage an Electric Medication Administration ... (click for more)

Roy Exum: General Boykin Helps ‘Warriors’

General W.G. “Jerry” Boykin is one of the most fabled warriors in modern-day warfare. He is also one of the most polarizing men who has ever served his country. General Boykin, retired after 36 years as a soldier, spent 13 years in the secretive Delta Force. At one time he commanded the Green Berets and was in one some pretty impressive engagements. In 1980 he was in on the ... (click for more)