Macon hospital to pay $2.5 million to settle ambulance billing allegations Read more here: http://www.macon.com/news/local/arti

The Medical Center, Navicent Health has agreed to pay more than $2.5 million to settle allegations that it submitted bills for ambulance trips that were either inflated or medically unnecessary.

The settlement follows a 27-month investigation — prompted by a whistleblower lawsuit filed by a former Navicent paramedic — of the hospital’s ambulance billing practices and allegations that it violated the False Claims and Georgia False Medicaid Claims acts, according to a statement from the U.S. Attorney’s Office.

The paramedic, Andre Valentine, will receive a share of the settlement payment, as will the federal government and the state. In his 2015 lawsuit, he claimed he was wrongfully terminated in 2014 after he questioned the hospital’s ambulance billing practices.

The agreement avoids costly litigation and doesn’t include any admission of liability, Ken Banks, general counsel for Navicent Health, said Thursday by email.

“We fully cooperated with the government throughout this process. We will continue to focus on improving our procedures,” he said. “Our delivery of high quality patient care was not affected by this issue.”

Here’s how the case unfolded, according to the statement:

The investigation revealed two “suspected schemes.”

The first alleged that nonemergency ambulance trips between hospitals were billed at an inflated rate, claiming they were for emergencies.

The second involved the billing of nonemergency ambulance trips for patients released from the hospital to their homes, skilled nursing facilities, hospital-based diagnostic clinics or dialysis centers also at an emergency rate.

It also was alleged that in many cases, ambulance trips weren’t medically necessary at all.

The hospital has a Corporate Integrity Agreement with the federal government requiring that the hospital maintain a program, overseen by the U.S. Department of Health and Human Services Office of Inspector General, to ensure compliance with laws and regulations regarding participation in federally funded programs.

As part of the settlement, the hospital’s agreement will be “heightened and extended to cover the newly resolved” conduct.

"Since Navicent owned and operated both the hospital and ambulances, profits from the systemic, deceptive practice of falsifying 'emergency' trips would fatten the hospital's bottom line," Derrick L. Jackson, special agent in charge of the Office of Inspector General, said in the statement. "With the power of sophisticated data analytics to augment traditional investigative work, bringing health organizations to justice is surer than ever.”

Ambulance billing “has long been an area of potential fraud on the Medicare and Medicaid programs,” U.S. Attorney G.F. “Pete” Peterman added in the statement. “This office will continue to vigorously investigate and pursue those who attempt to take advantage of the program.

“We will continue to police ambulance providers throughout Middle Georgia until the message has been received.”