Hospital to Pay $3.59 Million to Settle False Claims Act Allegations Involving Ambulance Services

By Miles Indest

A hospital located in Columbia, Tennesse, has agreed to pay the federal government over $3.5 million to settle False Claims Act allegations that occurred between 2004 and 2009. The hospital submitted a voluntary self-disclosure to the U.S. Attorney’s Office and the Department of Health and Human Services (DHHS) Office of Inspector General (OIG).

Hospital Voluntarily Self-Reported After Compliance Program Revealed Billing Errors.

The hospital self-reported after its own compliance program revealed billing problems for ambulance services. The hopsital’s audit of billings reported faulty claims and payment for:

  • Ambulance services that were billed with incorrect mileage units;
  • Ambulance services that were not medically necessary or for which medical necessity was not documented;
  • Ambulance services for which a physician certification statement (PCS) was not obtained;
  • Ambulance services for which the requisite signatures were not obtained; and
  • Ambulance services that were assigned an incorrect transport level.

Hospital Works With U.S. Attorney’s Office to Resolve Billing Errors.

After notifying the U.S. Attorney’s Office that billing issues had been discovered, Maury Regional outlined a plan to determine the scope of these issues. The hospital then worked with the U.S. Attorney’s Office to bring the matter to resolution.

Ambulance Services Flagged for Medicare Audits.

In a Medicare audit of a hospital or ambulance company, ambulance services are frequently chosen for review. Ambulance services companies have increasingly become a target for Medicare audits and are often accused of billing Medicare for unnecessary services. Ambulance companies should have a compliance plan in place to assist in detecting any errors. Ambulance companies should also take all measures to prepare for a Medicare audit, before notice of an audit is received. To learn more about preparing for Medicare audits, click here.

Contact Health Law Attorneys Experienced with Medicare Audits and False Act Claims Cases.

The Health Law Firm represents ambulance companies, emergency transport services, physicians, medical practices, pharmacists, pharmacies, home health agencies, nursing facilities, hospitals, and other health provider in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving government health programs (Medicare, Medicaid, TRICARE). The Health Law Firm also represents health providers in False Claims Act cases.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources Include:

Humbles, Andy. “Maury Regional to Pay $3.5 Million to Settle False Claims Act Allegations.” Tennessean. (June 29, 2012). From: http://www.tennessean.com/article/20120629/NEWS21/306290078/Maury-Regional-pay-3-5-million-settle-False-Claims-Act-allegations

Staff. “Maury Regional Hospital to Pay $3.59 Million to Settle False Claims Act Allegations.” The Daily Herald. (June 29, 2012). From: http://www.columbiadailyherald.com/sections/news/local/maury-regional-hospital-pay-359-million-settle-false-claims-act-allegations.html

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