Was a top psychiatrist ‘imprisoning’ patients as part of a Medicare scam – or is he a victim of a smear campaign?

The former chair of the Arkansas State Medical Board is being sued by at least 25 former patients who claim they were held against their will in his psychiatric unit, and is further facing allegations of Medicare fraud from the state's attorney general's office.

Dr Brian Hyatt, one of the state's top physicians, is at the centre of the lawsuit. Former patients claim the doctor kept them locked up after they sought treatment for mental health problems, and proceeded to charge them the highest amount possible upon their eventual release.

No charges have been brought against the doctor. His attorney insists the allegations are an orchestrated smear campaign against the physician, while the Arkansas Attorney General's office believes he may have been running a Medicare fraud plot.

Here's what we know about the alleged imprisonment and fraud scheme.

At least 25 of Dr Hyatt's former patients claim in a lawsuit that after seeking treatment for mental health issues they were held in medical facilities against their will.

One former patient, William VanWhy, told NBC News he checked himself into Northwest Medical Centre in Arkansas last year after feeling emotionally overwhelmed.

He remained in the facility for four days despite wanting to leave, and told the outlet "I was not receiving any medical care at all."

While mental health patients in Arkansas can be held against their will for up to 72 hours if they are considered a danger to themselves or others, doctors must obtain a court order and judge's consent to hold a patient any longer.

There was no petition filed in Mr VanWhy's case.

With the help of his partner and a lawyer, Mr VanWhy was eventually released. On the way out of the facility, a nurse commented that they were "glad he's getting out," before asking the trio not to "repeat that." The comment was captured on the body camera footage of a deputy who had been dispatched to execute a court order demanding Mr VanWhy's release.

Mr VanWhy told the deputy that he saved his life.

It was the second time in as many months that a sheriff's deputy was required to execute an order forcing Dr Hyatt to release a patient.

While Mr VanWhy was held for only four days, some former patients claim they were kept for weeks.

What possible reason could a doctor have for holding patients against their will?

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Aaron Cash, a lawyer representing Mr VanWhy and other former patients of Mr Hyatt, said he has an idea.

“I think that they were running a scheme to hold people as long as possible, to bill their insurance as long as possible before kicking them out the door, and then filling the bed with someone else,” he told NBC News.

Once the patients were allowed to leave, Dr Hyatt allegedly billed Medicaid "at the highest severity code on every patient," according to a search warrant affidavit obtained from the Arkansas Attorney General's office.

The Arkansas attorney general, Tim Griffin, has accused the doctor of running an insurance scam.

The investigation ultimately led to Dr Hyatt's resignation from the state board, though he insisted his leaving was not an admission of guilt.

“I am not resigning because of any wrongdoing on my part but so that the Board may continue its important work without delay or distraction,” he wrote in a letter at the time of his resignation. “I will continue to defend myself in the proper forum against the false allegations being made against me.”

Northwest Medical Centre in Springdale terminated his contract in May 2022, shortly after his resignation.

The hospital eventually agreed to settle with the attorney general's office to the tune of $1.1m after it failed to provide sufficient evidence that 246 patients held in Mr Hyatt's unit were justified.

The hospital denied any wrongdoing and insisted its personnel were in compliance with the law.

“We believe hospital personnel complied in all respects with Arkansas law, which heavily relies on the treating physician’s assessment of the patient, including in decisions related to involuntary commitment,” a spokesperson for the hospital said in a statement.

Dr Hyatt has maintained his innocence.

“Dr. Hyatt continues to maintain his innocence and denies the allegations made against him,” Dr Hyatt's attorney said in a statement to Arkansas Business last month. “Despite his career as an outstanding clinician, Dr. Hyatt has become the target of a vicious, orchestrated attack on his character and service. He looks forward to defending himself in court.”

The Independent has reached out for comment.

Between January 2019 and June 2022, Medicare payouts to the facility exceeded $800,000. The state attorney general's office said in an affidavit that the "claims are so high they skew the averages on certain codes for the entire Medicaid program in Arkansas," calling Dr Hyatt's billing practices "a clear outlier."

The affidavit says that 99.5 per cent of Dr Hyatt's Medicaid claims were made at the most expensive code. Typically patients arrive and are billed at the highest code as they are often dealing with serious issues when they first arrive. However, as they continue their stay those codes typically decline in cost as their conditions improve before release.

Exacerbating the claims of imprisonment and exorbitant billing are former patients' allegations that they did not even receive treatment during their time in the hospital.

Dr Hyatt became the medical director of Northwest Medical Centre's behavioural health unit in January 2018. Shortly after, the facility's beds expanded from 25 to 75, and there was a sharp increase in Medicaid and Medicare claims, as well as private insurance claims, according to the state attorney general's office.

At the same time he was acting as medical director Dr Hyatt was also running his own private practice, Pinnacle Premiere Psychiatry in nearby Rogers, Arkansas.

In his insurance claims Dr Hyatt said he conducted daily, in-person evaluations with his patients at the hospital.

However, a former hospital staffer spoke out in April 2022, telling state investigators that the doctor was only at the facility "a few minutes each day" and that he had "no contact with patients."

That claim prompted investigators to review 45 days worth of surveillance footage from the hospital. They found that Dr Hyatt only entered a patient's room or interacted with them 17 times, for less than 10 minutes in total.

“Dr. Hyatt never had even a single conversation with the vast majority of patients under his care,” the AG's office said in an affidavit.

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Shannon Williams, 52, told NBC News that she was held at the facility for five days and given a sedative against her will. She sought treatment in February 2021 after learning her brother had died of Covid-19 while overseas. Being a nurse who worked in a Covid unit herself, the news pushed her to a breaking point, and she sought help.

She was eventually transferred to Dr Hyatt's unit, where she says she felt as though she were "in a prison" and said she was "terrified." Ms Williams noted that she never saw the doctor's face.

“All I saw of Dr. Hyatt was the back of his head in the hallway. I never even saw his face," she told the broadcaster.

Dr Hyatt's legal team has maintained that he "did not mistreat patients" and that he "followed the guidelines" of Medicaid billing "as he understands them," according to the New York Post.

“Medicaid billing is a complicated, and not always consistently administered, system that does not make it easy for providers,” the attorneys said.