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."


Dr. Judy Tingley Named VP And CEO Of Erlanger Heart And Lung Institute

Officials with the Erlanger Health System announced the appointment of internationally recognized cardiovascular healthcare administrator, Judy E. Tingley, DNP, MPH, RN, AACC, as vice president and CEO of Erlanger’s new Heart and Lung Institute.  Dr. Tingley will assume her new role at the Chattanooga-based health system in February.   Dr. Tingley previously served ... (click for more)

Blood Drive In Honor Of Local Cancer Patient Is Wednesday

Blood Assurance will hold a public blood drive next Wednesday from 1:30-8 p.m. at Waterville Baptist Church in honor of Sarah "Missy" Parris, a local wife and mother of seven who has been diagnosed with a bone marrow cancer. "It is a challenge to find blood for transfusions for Missy because her type is only found in 0.9% of the population. Missy's family and friends have partnered ... (click for more)

TN Board Of Regents To Meet Jan. 27, To Consider Search Criteria For Chattanooga State President

The Tennessee Board of Regents will meet in a special conference-call session  Friday, Jan. 27 , to consider and act on search criteria for the next president of Chattanooga State Community College. Gov. Bill Haslam, chairman of the Board of Regents, has called the special telephone meeting of the board for  3 p.m. CST  Jan. 27. Approval of the criteria for the ... (click for more)

School Board Approves 4-Year Contract Extension With Independent Bus Drivers, Who Say They Can Handle 100 Routes; Extension Given On Custodial Contract

The county school board on Thursday night extended the contract by four years of school bus owner operators, who said they could deliver on 100 bus routes. The board delayed until a special meeting at 12:30 p.m. on Saturday at Central High School the issue of whether to accept the offer of 100 contract routes. That would be handled by many of the current 49 owner operators taking ... (click for more)

Bakewell Mountain Community Thanks Commissioner Fairbanks

The residents of Bakewell Mountain want to formally thank Commissioner Randy Fairbanks for standing up for our community in protecting our property rights and families. He personally made several trips to our properties and homes to see how the proposed gun range would affect our daily lives with noise, traffic, and a decrease in property values. Sometimes the little guys need ... (click for more)

Roy Exum: Just One Year Later…

If I hadn’t actually seen it happen, I would never have believed it. Not only did I wonder if it could ever happen, more often than not my disgust and dismay of such rampant disorder has filled me with more gloom and doom than you’ll find in a liberal Democrat on this, Donald Trump’s Inauguration Day. But I have got to proclaim that Thursday night I have never been as proud of the ... (click for more)