In at least 12 of the 19 states where Acadia operates psychiatric hospitals, dozens of patients, employees and police officers have alerted the authorities that the company was detaining people in ways that violated the law, according to records reviewed by The Times. In some cases, judges have intervened to force Acadia to release patients.
Acadia, which charges $2,200 a day for some patients, at times deploys an array of strategies to persuade insurers to cover longer stays, employees said. Acadia has exaggerated patients’ symptoms. It has tweaked medication dosages, then claimed patients needed to stay longer because of the adjustment. And it has argued that patients are not well enough to leave because they did not finish a meal.
Psychiatric hospitals were once run by the government or nonprofit groups. But both have been retreating from psychiatric care. Today, for-profit companies are playing a bigger role, lured by the Affordable Care Act’s requirement that insurers cover mental health.
Acadia operates more than 50 psychiatric hospitals nationwide, and the bulk of its revenue comes from government insurance programs. More than 20 nonprofit health systems, including Henry Ford in Michigan and Geisinger in Pennsylvania, have teamed up with Acadia to open facilities.
It fills those beds in a variety of ways. Acadia markets directly to potential customers, encouraging them to “Skip the ER.” The company cultivates relationships with people like police officers and emergency responders in the hope that they will bring patients to Acadia.
Acadia also pitches itself to staff in hospital emergency rooms that have been inundated with patients seeking mental health care. Business-development teams make sales calls to the doctors and other hospital workers, passing out brochures and talking up the expertise of Acadia’s staff and its willingness to take difficult patients. Sometimes, they come bearing doughnuts.
In a few states, Acadia has dispatched teams to overwhelmed E.R.s to help them determine whether patients need to be hospitalized. These employees, known as assessors, are supposed to be objective. But several said Acadia scolded them when they suggested that patients be sent to other psychiatric hospitals.
Once Acadia gets patients in the door, it often tries to hold them until their insurance runs out.
Acadia goes to great lengths to convince insurers that the patients should stay as long as possible, often around five days.
To do that, Acadia needs to show that patients are unstable and require ongoing intensive care. Former Acadia executives and staff in 10 states said employees were coached to use certain buzzwords, like “combative,” in patients’ charts to make that case.
In 2022, for example, state inspectors criticized an Acadia hospital in Reading, Pa., for having instructed workers to avoid adjectives like “calm” and “compliant” in a patient’s chart. That same year, employees at Acadia hospitals in Ohio and Michigan complained to their state regulators that doctors had written false statements in patients’ medical charts to justify continuing their stays.
At an Acadia hospital in Missouri, three former nurses said, executives pressured them to label patients whose insurance was about to run out as uncooperative. Acadia employees then would argue to insurance companies that the patients weren’t ready to leave. Sometimes, the nurses said, they wrote patients up for not finishing a meal or skipping group therapy.
Once Acadia won more insurance days for patients, it often would not release them before their insurance ran out, according to dozens of former Acadia executives, psychiatrists and other staff members.
“If there were insurance days left, that patient was going to be held,” said Jessie Roeder, who was a top executive at two Acadia hospitals in Florida in 2018 and 2019.
Under state laws, patients generally must pose an imminent threat to themselves or others in order to be held against their will in a psychiatric facility. Even then, hospitals can hold people for just a handful of days, unless the patients agree to stay longer or a judge or a medical professional determines that they are not ready to leave.
In Florida, the limit for holding patients against their will is 72 hours. To extend that time, hospitals have to get court approval.
Acadia’s North Tampa Behavioral Health Hospital found a way to exploit that, current and former employees said.
From 2019 to 2023, North Tampa filed more than 4,500 petitions to extend patients’ involuntary stays, according to a Times analysis of court records.
Simply filing a petition allowed the hospital to legally hold the patients — and bill their insurance — until the court date, which can be several days after the petition is filed. Mr. Blair, the Acadia spokesman, said this was often necessary to provide enough care to stabilize patients.
Judges granted only 54 of North Tampa’s petitions, or about 1 percent of the total.
