Wayne Medical Center, an 80-bed hospital under the Maury Regional Medical Centerumbrella, has agreed to pay $883,451 to the U.S. government to settle False Claims Act allegations self-reported by the hospital in 2012.
According to a release put out by the U.S. Attorney’s Office for the Middle District of Tennessee, the hospital’s compliance program prompted an investigation into the hospital’s billing for ambulance transport as part of its emergency medical services.
The Middle Tennessee District has seen asteady increase in the number of whistleblower lawsuits being filed here since U.S. Attorney Jerry Martin took the helm nearly three years ago, and shifted resources to accommodate the handling of more civil lawsuits like health care fraud. In his tenure, Martin has made a public push urging companies that suspect fraud to come forward and work with the government.
By self-reporting the allegations, Wayne Medical Center potentially saved itself thousands of dollars in fines in addition to the inherent costs associated with launching an investigation that is more adversarial in the discovery phase. Maury Regional Medical Center struck a similar deal with Martin’s office last year, agreeing to pay $3.6 million to settle Medicare billing violations that were self-reported.
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Under the False Claims Act, defendants can face fines between $5,000 and $11,000 per claim that the judge finds were knowingly submitted falsely, in addition to treble damages. When self-reported, the fines are usually taken off the table, according to Martin.
The following are excerpts from today’s news release:
Based upon an audit of billings conducted by Wayne Medical Center, the United States alleged that Wayne Medical Center submitted certain claims and received payment for: (1) ambulance services that were not medically necessary or for which medical necessity was not documented; (2) ambulance services for which a Physician Certification Statement was not obtained; (3) ambulance services that were assigned an incorrect transport level; (4) ambulance services for which the requisite signatures were not obtained; and (5) ambulance services that were billed with incorrect mileage units. The time period covered by the settlement agreement spans January 1, 2004, through December 31, 2009.
“Today’s announced settlement is another example of the benefit to providers of self-reporting billing issues directly to the United States Attorney’s Office,” said U.S. Attorney Jerry E. Martin. “Wayne Medical Center avoided the costs associated with a protracted investigation and the risks of potential fines under the False Claims Act. By doing the right thing and coming forward, they were treated fairly and were able to quickly and efficiently put this matter behind them.”