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. – February 5, 2019 - Tennessee Health Management, Inc. (“THM”) has agreed to pay $9,764,107.98 to settle allegations that it violated the False Claims Act, announced U.S. Attorney Don Cochran for the Middle District of Tennessee. The alleged conduct involved the submission of false claims for payment to TennCare, Tennessee’s Medicaid Program, related to nursing facility services to TennCare beneficiaries.
"Enforcement of the False Claims Act remains a priority of the Department of Justice and this Office,” said U.S. Attorney Cochran. “When violations are discovered, corporations should seek to immediately cooperate and resolve the allegations and minimize future risks, as THM has done here.”
TennCare requires that a placement evaluation be conducted and certified by a physician for each patient entering a nursing home. This settlement resolves allegations by the United States and the State of Tennessee that during the period of January 1, 2010 through December 31, 2017, THM submitted pre-admission evaluations with photocopied or pre-signed physician signatures on the required certifications for claims rendered to TennCare beneficiaries at its associated Tennessee skilled nursing and rehabilitation facilities. THM operates 27 skilled nursing facilities in the State of Tennessee.
"The cooperation between our Medicaid Fraud Control Unit and our federal partners in investigations such as this is critical in the pursuit of false claims, to ensure the vulnerable members of our community receive the quality of care they need and deserve," says TBI Director David Rausch.
Under the terms of the settlement, the United States will receive $5,455,207.13 and the State of Tennessee will receive $4,308,900.85. THM will also enter into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services-Office of Inspector General.
This matter was investigated by the Tennessee Bureau of Investigation-Medicaid Fraud Control Unit and the United States Attorney’s Office for the Middle District of Tennessee. The United States is represented by Assistant U.S. Attorney Sarah K. Bogni. The claims settled by this agreement are allegations only and there has been no determination of liability.
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Public Information Officer