California Hospital Settles Medicare Scam for $5.15 Million

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A whistleblower lawsuit filed in 2001 by a former employee has led to a settlement of $5.15 million by Simi Valley Hospital in Ventura County, just north of Los Angeles.

The civil lawsuit claimed that the hospital filed false Medicare and Medi-Cal claims arising from services in the hospital’s Behavioral Medicine Services Department. The employee filing the claim was the department’s former program director and later its administrative director.

The hospital allegedly billed $12,000 per month for a medical director to run a non-existent program for women suffering from post-traumatic stress disorder. The lawsuit also claimed that the hospital improperly provided psychiatric care for patients that were being treated for chemical dependency, and sought reimbursement for overnight hospital stays for patients that did not qualify for the service.

The investigation was being conducted by the U.S. Department of Health and Human Services. A statement released by the hospital said “We believe that our hospital follows fair and accurate billing practices, and are settling to avoid the expense and inconvenience of lengthy litigation.”

The San Diego Union-Tribune

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