Tennessee Hospital Pays $1.32 Million To Settle Allegations Of Improper Medicare And Medicaid Billing
Jackson, TN - Jackson-Madison County General Hospital has paid the United States $1,328,465 to resolve allegations that it billed Medicare and Medicaid in connection with the placement of unnecessary cardiac stents and other unnecessary cardiac procedures.
Cardiac stents are mesh tubes placed in coronary arteries to keep the arteries open in the treatment of coronary heart disease. The other related procedures include angioplasty, catheterization, and ultrasound imaging.
Under federal law, Medicare and Medicaid reimburse hospitals only for procedures that are medically necessary. The settlement with Jackson-Madison County General Hospital resolved claims that it billed Medicare and Medicaid for these unnecessary procedures performed from January 2004 through December 2011.
"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 D. Deming, received a share of the settlement amount.
The case is captioned United States ex rel. Wood D. Deming v. Jackson-Madison County General Hosp., et al., Case No. 07-1116-SHL (W.D. Tenn.) The claims settled by this agreement are allegations only, and there has been no determination of liability.