Regional Hospital Settles False Claims Act Allegations for $3.6 Million After Voluntary Disclosure

Maury Regional Medical Center in Nashville, Tennessee has agreed to pay $3.6 million to settle False Claims Act allegations that it overcharged Medicare for ambulance services.

After the 275-bed hospital’s compliance program discovered that some ambulance trips had been made for medically unnecessary issues and that the paperwork for some trips was incomplete or incorrect, the hospital voluntarily disclosed the overcharges to the local U.S. Attorney and the Office of Inspector General for the Department of Health and Human Services.

Based upon an audit of billings conducted by Maury Regional, the government alleged that medical center submitted certain claims and received payment for: (1) ambulance services that were not medically necessary or for which medical necessity was not documented; (2) ambulance services for which a Physician Certification Statement was not obtained; (3) ambulance services that were assigned an incorrect transport level; (4) ambulance services for which the requisite signatures were not obtained; and (5) ambulance services that were billed with incorrect mileage units.  The time period covered by the settlement agreement spans January 1, 2004, through December 31, 2009.
 
The hospital blamed an outside company that processed billing for ambulance transport claims with Medicare.  Those billing functions have since been brought in house.

The government commended Maury Regional for making the disclosure and for working closely with enforcement agencies to resolve the problems now and going forward.

John Howley, Esq.
New York, New York