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Justice News

Department of Justice
U.S. Attorney’s Office
Western District of Tennessee

Tuesday, July 14, 2015

Tennessee Hospital Agrees to Pay $510,000 to Settle Allegation of Improper Medicare, Medicaid Billing

Jackson, TN - Regional Hospital of Jackson has agreed to pay the United States $510,000 to resolve allegations that it billed Medicare and Medicaid for unnecessary cardiac procedures over an eight-year period.

The hospital agreed to the half-million dollar settlement on Friday, July 10th. According to the allegations, from January 2004 to May 2012, Regional Hospital defrauded Medicare and Medicaid in connection with the placement of unnecessary cardiac stents and other needless cardiac procedures. Stents are mesh tubes placed in coronary arteries to keep the arteries open in the treatment of coronary heart disease. The other related procedures included angioplasty and catheterization.

Medicare is a federally funded and administered health care program serving people aged 65 and older and others with disabilities. Furthermore, Medicaid is a federal program that provides health care services to qualifying indigent individuals. Under federal law, both Medicare and Medicaid reimburse hospitals only for procedures that are medically necessary.

"Billing Medicare for cardiac procedures that are not necessary or appropriate contributes to the soaring costs of health care and harms patients," said Edward L. Stanton III, United States Attorney for the Western District of Tennessee. "Settlements like this protect public funds and safeguard the beneficiaries of federal health care programs."

The allegations resolved by the settlement were raised in a lawsuit filed against the hospital under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. As part of the settlement, the whistleblower, Dr. Wood M. Deming, received a share of the settlement amount.

The claims settled by this agreement are allegations only, and there has been no determination of liability.

Updated July 14, 2015