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 – U.S. Attorney Henry C. Leventis announced today that the United States has reached an agreement with Meharry Medical College to settle allegations of violating the False Claims Act (FCA). Under the terms of the agreement, Meharry will pay $100,749 to resolve the allegations.
The United States alleged that, from 2016 until March 2020, Meharry submitted fraudulent claims to Medicare seeking payment for physician services provided in the internal medicine, OB/GYN, and psychiatric outpatient clinics, and for psychiatric consultations at Nashville General Hospital. In reality, these services were performed by unsupervised, non-physician residents.
“Combating healthcare fraud is a top priority for our office” said United States Attorney Leventis. “The allegations in this case not only constitute fraud on Medicare, but also an unacceptable risk to patients. We appreciate that Meharry agreed to implement changes to its policies to ensure compliance with Medicare’s supervision requirements regarding care provided by residents.”
As a condition of the settlement agreement, Meharry has also agreed to implement a Medicare billing policy designed to ensure compliance with Medicare billing requirements and will provide annual training to its faculty members and in-coming first-year residents concerning Medicare billing requirements for professional services provided by residents.
"To protect the integrity of federal health care programs and the patients they serve, it is important that providers are compliant with supervision requirements and other regulations," said Tamala E. Miles, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General. "HHS-OIG remains committed to promoting compliance and preventing fraud, waste, and abuse in HHS programs."
The litigation resolved by this case originally was brought under the qui tam or whistleblower provisions of the FCA by Dr. Rachel Thomas, a former internal medicine and hospitalist physician employed by TeamHealth, which was then under contract to staff the emergency room at Nashville General Hospital. Under the whistleblower provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery.
The resolution obtained in this matter was the result of a coordinated effort between the U.S. Attorney’s Office for the Middle District of Tennessee and the U.S. Department of Health and Human Services Office of Inspector General. Assistant U.S. Attorney Wynn M. Shuford represented the United States.
The claims in the settlement are allegations only, and there has been no determination of liability.
The case is captioned as United States ex rel. Thomas v. Meharry Medical College, Case No. 3:20-cv-00658 (M.D. Tenn.).
The investigation and resolution of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
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Public Affairs Officer