NASHVILLE, Tenn. (WTVF) — Maury Regional Medical Center has agreed to pay $1,702,903 to settle billing errors that resulted in Medicare overpayment.
An internal investigation found there was improper billing for certain inpatient services. In one example, Maury Regional Medical Center concluded that certain diagnosis-related groups ("DRGs") like stroke and pneumonia may not have been reasonable, allowable, or documented in accordance with Medicare Part A requirements.
“This settlement is based on the findings of our own internal review, during which we engaged the expertise of an independent auditor. After identifying errors through this audit, we accepted the responsibility to self-report our documentation concerns to the government,” said MRMC CEO Alan Watson.
After that internal investigation, the medical center submitted a voluntary self-disclosure to the U.S. Attorney's Office and to the Office of Inspector General for the Department of Health and Human Services. The U.S. Attorney's Office found that from April 1 2013 through March 31 2019, MRMC submitted claims and received payments which were not supported by medical records.
In a press release from MRMC, Watson says the center has been setting aside funds since first learning of this matter and initiating the self-disclosure process. The government has agreed to allow the organization to make repayment over a two-year period.
“We take our responsibility to accurately document and bill very seriously. Since discovering the concerns, we have worked closely with government officials to fully correct this issue and ensure that our current billing practices meet all regulations,” Watson said.
A spokesperson from MRMC says the medical center 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.
“Maury Regional is again to be commended for its transparency and diligence in handling the disclosure of these aberrant billing issues,” said U.S. Attorney Cochran. “As in the past, Maury Regional swiftly implemented a protocol to address the problem going forward and developed a plan to determine the scope of the issues to be remedied, with which we agreed. It worked closely and quickly with us to bring this matter to a satisfactory resolution, even in the midst of the challenges it is facing in light of the novel coronavirus pandemic It is particularly important for this office to be able to work together with our rural hospitals at this time, and we will continue our efforts to maintain the integrity of the federal health care programs, while meeting the needs of communities throughout the Middle District of Tennessee.”
The United States encourages all health care providers to self-disclose any known violations that have resulted in the submission of improper claims to federal health care programs.
