Maury Regional Hospital to Pay $3.59 Million
to Settle False Claims Act Allegations
Maury Regional Hospital, d/b/a Maury Regional Medical Center, has agreed to pay the United States $3,594,451.90 to settle False Claims Act allegations, announced Jerry E. Martin, U.S. Attorney for the Middle District of Tennessee.Maury Regional submitted a voluntary self-disclosure to the U.S. Attorney’s Office and 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 Maury Regional, the United States alleged that Maury Regional 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.
“Maury Regional is to be commended for the manner in which the hospital handled the disclosure of these billing issues once the issues came to light through the hospital’s compliance program,” said U.S. Attorney Jerry E. 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. Self-disclosure by providers is critical to the protection of the integrity of the federal health care system and this office is committed to bringing voluntary disclosures to resolution as quickly and as efficiently as is reasonably possible.”
“Maury Regional was transparent in their disclosure to the government and ultimately saved the taxpayers the cost associated with a federal investigation,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General for the Atlanta region. “OIG and the United States Attorney’s Office will continue to work with healthcare providers to return substantial dollars back to Medicare.”
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. The 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 and the Tennessee Attorney General’s Office. Assistant U.S. Attorney Matthew Curley represented the United States.