Healthcare News & Insights

Hospital pays millions to settle False Claims Act allegations

Maury Regional Hospital, in Columbia, TN,  made a voluntary self-disclosure to the feds after it discovered billing problems for ambulance services. Now it’ll pay $3.59 million to settle the False Claims Act allegations.

The self-disclosure, which was made to the U.S. Attorney’s Office and the Office of Inspector General for the Department of Health and Human Services, was discovered by the hospital’s compliance program. It then prompted an investigation of the facility’s billing for ambulance transport as part of its emergency medical services.

Based on an audit by Maury Regional Hospital, the United States alleged that the facility submitted certain claims and was paid for ambulance services:

  • that weren’t medically necessary or for which medical necessity wasn’t documented
  • for which a Physician Certification Statement wasn’t obtained
  • that were assigned an incorrect transport level
  • for which the requisite signatures weren’t obtained, and
  • that were billed with incorrect mileage units.

The time period covered by the settlement agreement spans Jan. 1, 2004, through Dec. 31, 2009.

The facility is to be commended for the manner in which it handled the disclosure of the billing issues once it was discovered by the hospital’s compliance program, noted U.S. Attorney Jerry Martin. “After notifying this office that the billing issues had been discovered, Maury Regional outlined its plan to determine the scope of these issues, followed through on that plan and worked closely with us to bring this matter to resolution.”

The feds encourage all facilities and healthcare providers to self-disclose any known violations that have resulted in the submission of improper claims to federal healthcare programs. They’re committed to bringing voluntary disclosures to resolutions as quickly and as efficiently as is reasonably possibly.

Being transparent in a disclosure, as Maury Regional was, saves the government — and ultimately the taxpayers — the cost associated with a federal investigation. Not to mention the fact that it puts the hospital in a good light — establishing the fact it wants to correct its mistakes.

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