Wayne Medical Center To Pay $883,000to Settle False Claims Act Allegations

Wayne Medical Center, located in Waynesboro, Tenn., has agreed to pay the United States $883,451.40 to settle False Claims Act allegations, announced Jerry E. Martin, U.S. Attorney for the Middle District of Tennessee.

Wayne Medical Center submitted a voluntary self-disclosure to the U.S. Attorney’s Office and to the Office of Inspector General for the Department of Health and Human Services.  The self-disclosure, discovered by the hospital’s compliance program, prompted an investigation into the hospital’s billing for ambulance transport as part of its emergency medical services.

Based upon an audit of billings conducted by Wayne Medical Center, the United States alleged that Wayne 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.

“Today’s announced settlement is another example of the benefit to providers of self-reporting billing issues directly to the United States Attorney’s Office,” said U.S. Attorney Jerry E. Martin.  “Wayne Medical Center avoided the costs associated with a protracted investigation and the risks of potential fines under the False Claims Act.  By doing the right thing and coming forward, they were treated fairly and were able to quickly and efficiently put this matter behind them.”

"This case is an excellent example of collaboration between the health care community and the law enforcement community coming together to serve the American taxpayer," said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. "When this hospital realized it had received inappropriate Medicare payments, it brought the matter to the attention of the U.S. Attorney's Office and refunded the money to the Medicare Trust Fund. We certainly hope that other health care providers will do the same when they realize they have been overpaid."

The United States encourages all health care providers to self-disclose any known violations that have resulted in the submission of improper claims to federal health care programs.
This case was investigated by the Department of Health and Human Services - Office of Inspector General and the U.S. Attorney’s Office for the Middle District of Tennessee. Assistant U.S. Attorney Mark H. Wildasin represented the United States.