MACON HOSPITAL SETTLES WITH STATE AND FEDS

NAVICENT SETTLES AMBULANCE FRAUD CLAIMS FOR OVER $2.5MM

G.F. "Pete" Peterman, III, United States Attomey for the Middle District of Georgia, and Georgia Attomey General Christopher M. Carr announced today a civil settlement with The Medical Center of Central Georgia, Inc., dlbla The Medical Center, Navicent Health ("Navicent"). Navicent agreed to pay to the United States and the State of Georgia $2,549,742to resolve allegations that it violated the False Claims Act and the Georgia False Medicaid Claims Act by submitting bills for ambulance transports that were either inflated or medically unnecessary.

Additionally, Navicent's current Corporate Integrity Agreement (CIA) will be heightened and extended to cover the newly resolved conduct. A CIA is an agreement between a private provider of services and the United States whereby the provider, at its own expense, institutes and maintains a program, overseen by the OIG with reviews by an independent review organizatron, to insure compliance with the laws and regulations regarding participation in federally funded programs.

The settlement marks the end of a 27-month investigation into Navicent's ambulance billing practices. The investigation revealed two suspected schemes through which Navicent allegedly violated the False Claims Act and the Georgia False Medicaid Claims Act. The first alleged scheme resolved by the settlement concerns non-emergency ambulance transports between hospitals that Navicent billed at an inflated rate by claiming the ambulance trips were emergency trips. The second alleged scheme resolved by the settlement concems the billing of non-emergency 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.

This investigation began with a lawsuit filed by Andre Valentine, a former Navicent paramedic, under the whistleblower provisions of the False Claims Act and the Georgia False Medicaid Claims Act. These statutes allow private citizens to bring civil actions on behalf of the Government and share in any recovery obtained. The case is captioned United States and the State of Georgia, ex rel. Andre Valentine v. Navicent Hospital, Inc., 5:15-cv-152 in the United States District Court for the Middle District of Georgia. Mr. Valentine will receive a share of the settlement payment pursuant to the whistleblower provisions of these statutes. While Mr. Valentine's complaint focused on transports between hospitals, the U.S. Department of Health and Human Services Office of Inspector General (OIG) independently identified for investigation Navicent's billing of emergency ambulance transportation for services provided to patients from the hospital to destinations such as skilled nursing facilities and patient residences.