Maury Regional Hospital, d/b/a Maury Regional Medical Center, has agreed to pay $1,702,903 to settle False Claims Act allegations, announced US Attorney Don Cochran for the Middle District of Tennessee. Maury Regional submitted a voluntary self-disclosure to the US Attorney’s Office and to the Office of Inspector General for the Department of Health and Human Services, which was prompted after an internal investigation concluded that there was aberrant billing for certain inpatient services. Specifically, Maury Regional concluded that certain diagnosis-related groups (“DRGs”) with complications or comorbidities (“CCs”) or major complications or comorbidities (“MCCs”) ― specifically stroke, respiratory infection, simple pneumonia, and septicemia ― may not have been reasonable, allowable, or documented in accordance with Medicare Part A requirements. Based upon the results of Maury Regional’s investigation, the United States concluded that Maury Regional submitted claims and received payment for certain DRGs with CCs or MCCs, as described above, which were not supported by the medical records. The time period covered under this settlement agreement spans from April 1, 2013 through March 31, 2019. Maury Regional previously engaged in voluntary self-disclosures in 2012 and 2013. 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.
