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Wayne Medical Center to Pay $883,451.40 to Settle False Claims Act Allegations
Wayne Medical Center, located in Waynesboro, Tennessee, has agreed to pay the United States $883,451.40 to settle False Claims Act allegations, announced Jerry E. Martin, U.S. Attorney for the Middle District of Tennessee.
The allegations stem from the hospital’s billing for ambulance transport as part of its emergency medical services. An audit of billings conducted by the hospital itself revealed that they had submitted certain claims and received payment for ambulance services that were not medically necessary or for which medical necessity was not documented.
The United States alleged that Wayne Medical Center submitted claims for ambulance services that were not medically necessary, for which a Physician Certification Statement was not obtained, assigned an incorrect transport level, for which the requisite signatures were not obtained, and 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.”
This case is an excellent example of collaboration between the healthcare community and the law enforcement community coming together to serve the American taxpayer. When this hospital realized it had received inappropriate Medicare payments, it brought the matter to the attention of the U.S. Attorney’s Office and refunded the money to the Medicare Trust Fund.
The United States encourages all healthcare providers to self-disclose any known violations that have resulted in the submission of improper claims to federal healthcare programs.
Assistant U.S. Attorney Mark H. Wildasin represented the United States in this case.
Wayne Medical Center: Defendant, False Claims Act, Tennessee, 2004
Defendant: Wayne Medical Center
Criminal Charges: False Claims Act allegations
City and State: Waynesboro, Tennessee
Exact Date: January 1, 2004, through December 31, 2009 (settlement agreement period)
Sentence or Outcome: Agreed to pay $883,451.40
Dollar Amounts: $883,451.40
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Key Facts
- State: Tennessee
- Category: White Collar Crime
- Source: DOJ Press Release â†â€â€
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