WSPA Channel 7 News Columbia SC- Published: September 27, 2017, 10:58 am Updated: September 27, 2017, 12:37 pm

COLUMBIA, SC (WSPA) – AnMed Health has agreed to pay over $7 million to settle allegations that it submitted false Medicare claims.

A news release from the U.S. Attorney’s Office states “AnMed Heath 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.”

Prosecutors allege “AnMed Health billed for radiation oncology services for Medicare patients when a qualified practitioner was not immediately available to provide assistance and direction throughout the radiation procedure, as required by Medicare regulations.”

AnMed is also accused of billing a minor care clinic as if it was an emergency department and billed emergency department services as if they were provided by a physician, but were rendered by mid-level providers, according to the news release.

Prosecutors say those practices resulted in higher reimbursements to AnMed Health.

The allegations came to light following a lawsuit filed by Linda Jainniney. Prosecutors say Jainniney is a whistleblower who used to work for AnMed Health.

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

“Protecting people with Medicare and guarding health resources are top priorities,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “Provider organizations seeking to increase profits at the expense of patients and taxpayers should expect such plans to be costly.”

AnMed Health released the following statement:

“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.”

Jainniney will receive $1,202,500 of the United States’ False Claims Act recovery and $850,136.50 from AnMed Health to resolve her wrongful termination claims under the False Claims Act.

Questions about Medical claims, Coding, ACA, private Medical Insurance and health insurance reimbursement? Physician Credentialing and Revalidation ? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services at 512-243-6844