The Medical Center, Navicent Health in Macon, Ga., reached a settlement with the state regarding allegations of ambulance billing fraud, according to a statement from the United States Attorney Middle District of Georgia.
As part of the settlement, Navicent agreed to pay more than $2.5 million to resolve allegations it submitted ambulance bills "that were either inflated or medically unnecessary," the statement reads. Prosecutors argued Navicent violated the federal False Claims Act and the Georgia False Medicaid Claims Act by submitting the bills.
The U.S. Attorney's Office said Navicent's current Corporate Integrity Agreement with the federal government will also be "heightened and extended" as a result of the settlement.
An investigation into Navigant's ambulance billing practices began more than two years ago after former Navicent paramedic Andre Valentine filed a whistleblower lawsuit under the qui tam provision of the False Claims Act.
According to the U.S. Attorney's Office, the investigation revealed two alleged schemes. The office said one alleged scheme "concerns nonemergency ambulance transports between hospitals that Navicent billed at an inflated rate by claiming the ambulance trips were emergency trips," while the second "concerns the billing of nonemergency ambulance transports of patients released from the hospital to their residences, skilled nursing facilities, hospital-based diagnostic clinics or dialysis centers that Navicent billed as emergency transports in violation of ambulance billing rules."
"It was alleged that in addition to billing many of these transports at an inflated rate, for many of these transports it was neither appropriate nor medically necessary for Navicent to have used and billed for an ambulance at all," the U.S. Attorney's Office added.
Mr. Valentine is slated to receive a share of the settlement payment. The case did not make a determination of liability.
"We fully cooperated with the government throughout this process. We will continue to focus on improving our procedures. Our delivery of high quality patient care was not affected by this issue," Ken Banks, general counsel for Navicent, told The Telegraph via email.
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