Hospital included in Medicare filings
Published 12:08 am Thursday, May 14, 2015
NATCHEZ — Natchez Community Hospital was included last week in a $15 million settlement with the U.S. Justice Department over allegations of inappropriate Medicare filings.
The justice department alleges the hospitals in the settlement knowingly submitted Medicare claims for intensive outpatient psychotherapy (IOP) services that weren’t reasonably or medically necessary, weren’t part of the patient’s individualized treatment plan, weren’t properly documented or weren’t therapeutic in nature.
The justice department also alleged some of the patients didn’t qualify for the services, which are provided to individuals with mental disorders. The alleged incidents happened between 2005 until 2013.
Allegiance Health Management — a post-acute healthcare management company based in Shreveport — typically performed the IOP services on the hospitals’ behalf, but the services were billed to Medicare by the hospitals.
Natchez Community Hospital’s former owners — Health Management Associates (HMA), which has since merged with Community Health Systems (CHS) — reached the settlement with the United States government over 14 of its hospitals, including five in Mississippi. The HMA settlement is for $15 million.
A CHS subsidiary affiliated with Wesley Medical Center in Hattiesburg also agreed to pay $210,000 as part of the overall settlements with 16 hospitals in Mississippi, Arkansas, Florida, Georgia, North Carolina, Oklahoma and Texas.
“Hospitals that participate in the Medicare program must ensure that the services they provide and bill for are based on the medical needs of patients rather than the desire to maximize profits,” Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division said.
“The Department of Justice is committed to ensuring that those who seek to abuse the Medicare program will be held accountable for their actions.”
CHS spokesperson Tomi Galin said the resolution with the justice department was for conduct prior to the merger of HMA with CHS and “includes no admission of liability and in fact includes an express denial of liability on the part of these hospitals.”
Galin said the cases in question were covered in the legal arrangements that were part of the merger, and that CHS is “pleased to be able to reach an amicable resolution with the Department of Justice of these claims.”
The settlements were the result of a lawsuit filed under the False Claims Act. The act allows private individuals known as “relators” to sue on behalf of the United States and receive a portion of the proceeds in a settlement or judgment. The relator in these settlements will receive $2,667,300.