US Attorney: AnMed agrees to $7 million settlement for submittin - FOX Carolina 21

US Attorney: AnMed agrees to $7 million settlement for submitting false Medicare claims

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AnMed Hospital (Oct. 8, 2014/FOX Carolina) AnMed Hospital (Oct. 8, 2014/FOX Carolina)

The US Attorney’s Office stated Wednesday that AnMed Health, the hospital system based in Anderson, South Carolina, has agreed to pay more than $7 million after submitting false Medicare claims.

The US Attorney’s Office said in the statement that the settlement resolved allegations that AnMed Health “knowingly disregarded the statutory conditions for submitting claims to the Medicare program for a variety of services, including radiation oncology services, emergency department services, and clinic services.”

The suit alleged that AnMed billed for radiation oncology services when a qualified practitioner was not participating in the procedure, as required by Medicare regulations.  The suit also alleged that AnMed systematically billed a minor care clinic as an Emergency Department, and billed Emergency Department services even when the services were not rendered by a physician.

Those billing practices led to higher Medicare reimbursements being paid to AnMed Health.

“Our goal in pursuing Medicare fraud is not only to protect taxpayers, but also to ensure that Medicare beneficiaries receive the quality care they deserve,” said Barbara Bowens, Civil Chief for the U.S. Attorney’s Office for the District of South Carolina.

“This is another example of how the False Claims Act whistleblower provisions help protect the public’s interest,” added U. S. Attorney John Horn.  “It also reflects our ongoing commitment to safeguard our federal health care programs and the vital care that they provide.”

The allegations were first raised in a lawsuit filed by a whistleblower formerly employed by AnMed Health under the whistleblower provisions of the False Claims Act, per the statement. 

AnMed admitted in a statement that they found through an investigation launched in 2013 that  some of their billing practices fell short of their regulatory obligations. 

Below is the full statement AnMed released Wednesday:

The very complicated and frequently changing rules and regulations governing how we bill Medicare create inherent difficulties in maintaining constant compliance. These regulatory efforts lead to frequent challenges for health care systems and other providers across the nation. We discovered through an investigation started in 2013 that some of our billing practices fell short of our regulatory obligations.  In response to the investigation, and in an effort to exceed the expectations of both our customers and regulatory authorities, we launched a thorough review of our processes and reported the results to the authorities. We were able to reach a mutually acceptable settlement with the federal government, including a five-year corporate integrity agreement, to ensure our activities remain compliant.  We are glad to report that the billing errors were largely technical and did not compromise the quality of the care delivered at AnMed Health. We also were pleased that neither our review, nor that of the OIG, revealed any intentional misconduct or criminal wrongdoing.

Our review revealed opportunities to improve billing practices in a very small percentage of AnMed Health’s Medicare claims, but these opportunities are important for our regulatory compliance.  We have taken actions to correct all affected processes, including the way we keep records and bill for technical services.

We also removed the vendor who provided certain billing and coding services and ramped up our compliance and audit functions to help prevent future errors and ensure that if errors take place in the future, we will be the first to discover them.

We are glad to have this matter fully resolved and we look forward to continuing to provide compassionate, high-quality care for the patients of AnMed Health.

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