Annapolis, Maryland-based Anne Arundel Medical Center (AAMC) agreed to pay nearly $3.2 million to settle false claims allegations by the Department of Justice (DOJ).
The DOJ alleges that the hospital's Anticoagulation Clinic, where it monitors outpatient anticoagulation therapy such as the use of blood thinners like Coumadin, began submitting claims for blood tests that were not medically reasonable.
Patients who take those drugs are routinely tested to measure how long it takes their blood to clot and, if the results indicate the need to adjust the Coumadin dose or the patient presents with a change in medical condition, the provider may perform and charge for an Evaluation and Management (E/M) service.
However, DOJ officials allege that AAMC submitted false claims to Medicare, TRICARE, and the Federal Employees Health Benefits Program for E/M services that were not medically reasonable and necessary at the same time it submitted and was paid for claims for the blood tests.
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“Companies that submit false bills to the government must be held accountable,” said U.S. Attorney Robert K. Hur in a release. “The United States Attorney’s Office is committed to taking the steps necessary to protect Medicare and other federal healthcare programs from fraud and abuse and recover taxpayers’ money.”
AAMC officials said in a statement that the settlement is not an admission of liability by AAMC, which has denied the allegations, and that they believe their practices complied with federal laws and regulations and contributed to the improved health of patients. The DOJ pointed out it is also not a concession by the United States that its claims are not well founded.
"After cooperating fully with the Department of Justice, Anne Arundel Medical Center (AAMC) has reached a settlement on a billing error allegation," a spokesperson said in an emailed statement. "However, in the interest of avoiding litigation and incurring additional legal expenses, we decided it was in our best interest to settle. We remain deeply committed to a strong culture of compliance and resolute in the integrity of our billing processes."
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As part of the settlement, AAMC entered into a five-year Corporate Integrity Agreement with the HHS-OIG which requires them to implement a risk assessment and internal review process to identify and address evolving compliance risks on an ongoing basis.
The settlement resolves a lawsuit brought by Barbara McHenry, a former AAMC employee, under the whistleblower provisions of the False Claims Act. She will receive $473,100 as part of the settlement.
It's part of the DOJ's ongoing False Claims Act enforcement which resulted in more than $2.8 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending Sept. 30, 2018.