◆ Maury Regional Medical Center in Tennessee has agreed to pay $1.7 million to settle false claims allegations over MS-DRG coding, the U.S. Attorney’s Office for the Middle District of Tennessee said April 13.[1] After realizing there was “an aberrant rate of reimbursement” for certain DRGs with complications or comorbidities or major complications or comorbidities—stroke, respiratory infection, simple pneumonia and septicemia—the hospital did a self-audit, according to the settlement. “Based upon the results of the self-audit, Maury Regional made a voluntary disclosure to the United States.” Data from the Program for Evaluating Payment Patterns Electronic Report, better known as PEPPER, prompted the self-audit, said attorney John Joseph, with Post & Schell, who represented the hospital. Ultimately, the U.S. attorney’s office alleged the hospital submitted noncompliant claims for the DRGs from April 1, 2013, through March 31. In a statement, Maury Regional’s CEO, Alan Watson, said “This settlement is based on the findings of our own internal review, during which we engaged the expertise of an independent auditor.” The hospital statement said it “has developed a more robust pre-bill review process and conducted extensive education with staff. In addition, a member of the compliance team has attained additional certification in coding documentation and will be performing ongoing reviews for accuracy as well as engage independent auditors for periodic third-party reviews.” Contact Joseph at jjoseph@postschell.com.
◆ Logan Laboratories Inc., a reference laboratory in Tampa, Florida; Tampa Pain Relief Centers Inc.; and two of their former executives, Michael T. Doyle and Christopher Utz Toepke, have agreed to pay $41 million to settle false claims allegations,[2] the Department of Justice said April 15. They allegedly billed Medicare, Medicaid, TRICARE and other federal health care programs for medically unnecessary urine drug testing. Logan Labs and Tampa Pain are subsidiaries of Surgery Partners Inc., Doyle is the former CEO of Surgery Partners and Logan Labs, and Toepke is the former group president for ancillary services at Surgery Partners and a former vice president at Tampa Pain. The defendants didn’t admit liability in the settlement.
◆ The HHS Office of Inspector General has updated its Work Plan.[3]
◆ Ebenezer Quainoo, M.D., an internist in Baltimore, Maryland, has agreed to pay $436,000 to settle allegations that he submitted false Medicare claims for medically unnecessary autonomic nervous function tests and trigger point injections with the use of ultrasound guidance, the U.S. Attorney’s Office for the District of Maryland said April 15.[4] Quainoo, who operates Baltimore Health Care PC, didn’t admit liability in the settlement.