‘Group therapy sessions never happened,’ Asheville opioid facility lawsuit alleges

ASHEVILLE – A whistleblower suit alleging that an Asheville opioid treatment facility submitted insurance claims to the federal and state government for phantom group therapy sessions is on the ropes after an unfavorable July 27 recommendation from a federal district court magistrate.

Candler resident Lisa Wheeler filed the initial lawsuit Sep. 10, 2021, in U.S. District Court for the Western District of North Carolina. At the time of the filing, she was a physician assistant who worked as an independent contractor for Asheville Comprehensive Treatment Center, which provides treatments to adults struggling with painkiller or opioid addiction. At the time she filed the suit, she served as the assistant medical director for the facility. She is suing under the False Claims Act, which prohibits people from using false or fraudulent claims to receive payment from the government, according to the U.S. Civil Code. North Carolina’s law is also similar.

The North Carolina Department of Justice and the federal government declined to take on the lawsuit June 2, 2022, leaving Wheeler and her attorneys to pursue it on their own. Wheeler’s suit was unsealed June 7, 2022. Wheeler amended her complaint Aug. 1, 2022.

The Citizen Times reached out to the U.S. Department of Justice for comment. The North Carolina Department of Justice declined to comment.

Wheeler, who no longer works with the facility, alleges in her 118-page amended complaint that the Asheville Comprehensive Treatment Center’s parent company, Acadia Healthcare, and several of its subsidiaries, violated the federal and North Carolina False Claims Act by submitting false and fraudulent claims to Medicare, the federally run health insurance program for seniors and the disabled, and Medicaid, the state-run health insurance program for people with lower incomes. Acadia Healthcare has 246 locations across 39 states and Puerto Rico, according to its website.

The Citizen Times reached out to defendants’ attorneys Jennifer Weaver, Andrew Solinger, Anna Rasmussen, Philip Jackson and David Hawisher for comment. Hawisher and Jackson are based in Asheville and work for Roberts & Stevens. They also have represented Mission Hospital in cases recently reported by the Citizen Times.

Acadia has a history of submitting fraudulent claims to the government. In May 2019, the federal government announced a $17 million health care fraud settlement with Acadia. According to a news release from the U.S. Attorney’s at the time, the company’s West Virginia treatment centers sent urine and blood samples to a California laboratory for testing, paid the lab, and then billed West Virginia Medicaid as if they had done the tests themselves. Based on this finding, the company entered into a five-year corporate integrity agreement with the federal government, which requires the company to adhere to many guidelines outlined in the agreement or face further penalties.

Opioid Whistleblower Amended Complaint by Mitchell Black on Scribd

Fraudulent book reading therapy?

According to Wheeler’s amended complaint, she started noticing alleged fraudulent activity in September 2020. “The Asheville facility was documenting that they were doing group therapy, but they were not actually doing group therapy,” the legal filing read.

The documentation included group therapy notes that “often contained significant detail, include a description of dialogue between participants.” Wheeler’s legal filing asserts that counselors and therapists at the facility even reuse the same “fraudulent notes” for different patients, and for different days. The amended complaint cites several examples of group therapy notes representing sessions that did not occur.

“These notes often contained detailed quoted dialogue and comments from patients who purportedly participated in the group therapy session,” the amended complaint read. “But these group therapy sessions never occurred.”

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Wheeler believes Asheville Comprehensive Treatment Center sent bills for reimbursement to the federal and state government based on these fictitious sessions.

Wheeler argued that the fraud occurring at the facility escalated when employees began submitting fictitious bibliotherapy session documentation. A bibliotherapy therapy session is one during which patients read books or articles and then discuss the contents of that material with a therapist, according to the amended complaint. Wheeler said that the Asheville facility’s counselors and therapists copied and pasted templated group therapy notes, which were then submitted for reimbursement.

Wheeler argued that patients at the facility did not receive any meaningful therapy from counselors at the facility.

“Counselors and therapists at the Asheville facility often called patients, had a brief phone call with them, and documented the session as a full individual therapy session,” the amended complaint read.

Wheeler argued in her amended complaint that the system of billing fraudulent group therapy sessions to the government was corporate directives and extend beyond the Asheville facility. The clinical director of the Asheville facility, Jason Hines, told Wheeler that “this conduct was occurring at other North Carolina locations, including Defendants’ Pinehurst and Fayetteville locations.”

There are four elements necessary to prove an FCA claim, according to U.S. Magistrate Judge for the Western District of North Carolina W. Carleton Metcalf. Claims need to be proven as false, they need to be submitted knowingly, they need to influence payment and they need to be submitted to the government, he wrote in a July 27 memorandum and recommendation.

Opioid Whistleblower Response by Mitchell Black on Scribd

The defendants argued in their Sep. 16, 2022 motion to dismiss that neither Medicare nor Medicaid require group therapy, and Medicare’s bundled payment system does not allow for them to bill specifically for group therapy. They argue that because they could not specifically bill for group therapy, there could be no fraudulent group therapy bills. Defendants also noted that Wheeler was only an independent contractor at the Asheville Comprehensive Treatment Center.

The defense also argued that Wheeler does not have the specificity necessary to prove that the submission influenced payment. They say that Wheeler did not provide specific information about exactly when the defendants submitted claims. In their motion to dismiss, the defendants also argue that Wheeler did not show that the alleged claims were submitted to the federal government.

The defense did not argue that the group therapy sessions were not fictitious.

Carleton found the defense’s argument persuasive, saying that Wheeler only had specific information on the Asheville, Pinehurst and Fayetteville locations, and couldn’t make conclusions about the entire company. The magistrate also found that Wheeler’s claims were too general and that she did not show how the bills based on the false claims were submitted to the government. Carleton recommended to the presiding district judge that the case be dismissed.

Opioid Whistleblower Memo by Mitchell Black on Scribd

Opioid Whistleblower Memo by Mitchell Black on Scribd

Objections to Carleton’s conclusion must be filed within 14 days of his finding, according to the legal filing.

Wheeler’s attorney Bill Nettles said to the Citizen Times that her legal team “declines to comment on the pending motion.”

Have you received inadequate treatment from the Asheville Comprehensive Treatment Center? We want to know. Email Mitchell Black at mblack@citizentimes.com. Mitchell covers Buncombe County and health care for the Citizen Times. You can follow him on Twitter @MitchABlack. Please help support local journalism with a subscription to the Citizen Times.

This article originally appeared on Asheville Citizen Times: Asheville opioid treatment facility whistleblower lawsuit in jeopardy