UNITED STATES REACHES $37 MILLION SETTLEMENT OF FRAUD LAWSUIT AGAINST CIGNA FOR SUBMITTING FALSE AND INVALID DIAGNOSIS CODES TO ARTIFICIALLY INFLATE ITS MEDICARE ADVANTAGE PAYMENTS
NASHVILLE, Tenn. – April 14, 2020 – Maury Regional Hospital, d/b/a Maury Regional Medical Center, has agreed to pay $1,702,903 to settle False Claims Act allegations, announced U.S. Attorney Don Cochran for the Middle District of Tennessee.
Maury Regional 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, which was prompted after an internal investigation concluded that there was aberrant billing for certain inpatient services. Specifically, Maury Regional concluded that certain diagnosis-related groups (“DRGs”) with complications or comorbidities (“CCs”) or major complications or comorbidities (“MCCs”) - specifically stroke, respiratory infection, simple pneumonia, and septicemia - may not have been reasonable, allowable, or documented in accordance with Medicare Part A requirements.
Based upon the results of Maury Regional’s investigation, the United States concluded that Maury Regional submitted claims and received payment for certain DRGs with CCs or MCCs, as described above, which were not supported by the medical records. The time period covered under this settlement agreement spans from April 1, 2013 through March 31, 2019. Maury Regional previously engaged in voluntary self-disclosures in 2012 and 2013.
“Maury Regional is again to be commended for its transparency and diligence in handling the disclosure of these aberrant billing issues,” said U.S. Attorney Cochran. “As in the past, Maury Regional swiftly implemented a protocol to address the problem going forward and developed a plan to determine the scope of the issues to be remedied, with which we agreed. It worked closely and quickly with us to bring this matter to a satisfactory resolution, even in the midst of the challenges it is facing in light of the novel coronavirus pandemic It is particularly important for this office to be able to work together with our rural hospitals at this time, and we will continue our efforts to maintain the integrity of the federal health care programs, while meeting the needs of communities throughout the Middle District of Tennessee.”
“Effective compliance programs demonstrate an institution’s good faith effort to comply with Medicare rules and regulations,” said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “We welcome an opportunity to work with hospitals and other health care providers to protect taxpayer dollars and ensure this money is properly spent to improve the health of all Americans.”
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 United States Attorney’s Office for the Middle District of Tennessee and the Department of Health and Human Services, Office of Inspector General (HHS-OIG). Assistant U.S. Attorney Kara F. Sweet represented the United States.
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Public Information Officer