Maury Regional Medical Center, a not-for-profit regional health system that has three facilities in Spring Hill, has agreed to pay $1,702,903 to settle a False Claims Act allegation after an internal investigation revealed some discrepancies in Medicare billing for certain inpatient services.
The settlement came to light after an announcement from the Middle District of Tennessee State Attorney Donald Cochran on Tuesday, who in a statement praised Maury Regional for its willingness to hold itself accountable.
“Maury Regional is again to be commended for its transparency and diligence in handling the disclosure of these aberrant billing issues,” Cochran said in a statement. “As in the past, Maury Regional swiftly implemented a protocol to address the problem going forward and developed a plan to determine the scope of the issues to be remedied, with which we agreed.”
The report from Cochran reveals that Maury Regional conducted a self-audit of its Medicare billings after noticing abnormal rates of reimbursements for diagnosis-related groups. A diagnosis-related group is a classification system that places inpatient care and its related costs into categories of medical severity, all with the purpose of determining a cost to be later reimbursed through Medicare.
After conducting the self-audit, Maury Regional discovered that inpatient care related to patients with two chronic diseases or conditions, specifically stroke, respiratory infection, simple pneumonia and septicemia, were not as they should be, with billing discrepancies reported from April 1, 2013 through March 31, 2019.
After willingly submitting its findings to the U.S. Attorney’s Office and the Office of Inspector General for the Department of Health and Human Services, the state found that “Maury Regional submitted or caused to be submitted false claims for payment to the Medicare Program.”
As terms of the settlement, Maury Regional has been ordered to pay the more than $1.7 million in eight installments, each one roughly $213,000 through January 2022.
The hardships the coronavirus pandemic has brought Maury Regional, which include the furlough of 340 of its employees, did not escape Cochran, who further praised the medical center for its diligence during difficult financial times.
“[Maury Regional] worked closely and quickly with us to bring this matter to a satisfactory resolution, even in the midst of the challenges it is facing in light of the novel coronavirus pandemic,” Cochran said in a statement. “It is particularly important for this office to be able to work together with our rural hospitals at this time, and we will continue our efforts to maintain the integrity of the federal health care programs, while meeting the needs of communities throughout the Middle District of Tennessee.”