Psychiatric Solutions / Longview Psychiatric Center: The Physician Medicare Was Billed For

In the Psychiatric Solutions / Longview Psychiatric Center fraud case, a psychiatrist and his companies agreed to pay $3 million to resolve allegations of false Medicare billing for transcranial magnetic stimulation treatments and physician assessments. Two clinic workers brought the allegations that started the investigation.

The Justice Department announced the settlement on March 3, 2023. It named Psychiatric Solutions P.C., Longview Psychiatric Center PLLC and Longview Psychiatric Center LP, companies the psychiatrist owned and operated.

The brain stimulation treatment at the center of the allegations is often called TMS. The case reached both the treatment session and the physician work billed around it.

What the Longview Clinic Allegedly Billed

The government alleged that the clinic billed Medicare for transcranial magnetic stimulation procedures it never performed and routinely administered other treatments without a valid medical purpose. One concerns whether a session happened. The other concerns why the clinic put the patient through it.

For an absent-treatment claim, the appointment and the actual encounter are central. A billing entry represents a service on a particular date. We connect that representation to the patient’s attendance, the work performed and the people involved. A worker who knows the schedule can bring a different part of the story from someone who knows how the claims were submitted.

The unnecessary-treatment allegation reaches further into the clinic’s decisions. The government said patients faced intentional pressure to accept treatments they did not need. The two workers allegedly witnessed that pressure during their employment, along with false treatment records and billing for worthless or unprovided services.

We see a particularly ugly bargain in that allegation: the patient undergoes an unnecessary procedure, and the clinic gets to bill Medicare for it. The pressure on the patient belongs in the same account as the claim for payment.

The false-record allegation connects those decisions to what Medicare was told. The workers’ account concerned both what happened in the clinic and what the clinic recorded. We look at that relationship because a treatment note can tell a very different story from the person who was there. In this case, the government alleged that the records themselves were part of the false billing.

Physician Supervision Was Part of the Claim

The physician-assessment allegation was specific: the clinic billed Medicare when the physician did not see the patient or supervise the transcranial magnetic stimulation session. That gives an insider a separate question from whether the patient attended. Who actually performed the physician work represented by the bill?

On the bill, a physician. In the government’s account, no encounter or supervision.

This matters to more than the person submitting claims. Someone involved in treatment may know who assessed the patient. Someone responsible for scheduling may know who was available. Someone in billing may know which professional service the clinic charged. Their knowledge meets at the same patient encounter, even when their jobs keep them in different parts of the practice.

The Same Gap in Other Psychiatric Billing Cases

In a whistleblower complaint against Oglethorpe, the whistleblowers alleged that a medical director signed required physician documents while providing no oversight, a parallel to Longview’s alleged gap between physician paperwork and participation.

The government alleged that American Psychiatric Centers, doing business as Comprehensive Psychiatric Services, billed psychotherapy alongside office visits when that additional care was absent or inadequately documented, illustrating why Longview’s physician-assessment claims need scrutiny separate from the stimulation treatment.

The Workers, the Sale and the Settlement

The two clinic workers brought a qui tam case under the False Claims Act. The Justice Department said they allegedly witnessed the conduct during their employment.

According to the Justice Department’s description of the complaint, the alleged conduct continued until the business was sold in April 2022.

The Department of Health and Human Services Office of Inspector General and the FBI conducted the investigation. The U.S. Attorney’s Office for the Southern District of Texas handled the case.

How Much of a Settlement Does a Whistleblower Get?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. The Longview announcement also provided for a shared whistleblower award to the two workers who brought the case.

What Evidence Is Needed to Prove Fraud?

For a transcranial magnetic stimulation billing case like Longview, we connect the Medicare claim to the treatment, the reason for it, the physician’s involvement and the record supporting the charge. The clinic’s operational story matters at each point: who attended, who provided care, who assessed or supervised, and what the bill said happened.

You may know the treatment side, the scheduling side or the billing side. We work with you to understand what your role let you see and how it connects to the government’s payment. Our job is to turn that knowledge into a focused whistleblower case with the right expertise behind it.

You Know Who Was in the Treatment Room

If you saw a gap between the transcranial magnetic stimulation care patients received and the physician services Medicare was billed for, speak to one of our Whistleblower Experts about what happened inside the clinic. We build the case with you and bring in healthcare fraud whistleblower lawyers who understand treatment records, medical necessity and physician billing. We stay beside you from the first call, working to build the strongest Medicare whistleblower case your knowledge can support.