A settlement has been reached to resolve False Claims Act allegations against Navicent Health Inc.
The allegations arose from a lawsuit that claimed Navicent Health violated the False Claims Act and billed Medicare and Medicaid for ambulance trips that were overpriced or not medically necessary.
According to the United States, Navicent Health allegedly upcoded non-emergency hospital-to-hospital ambulance transports as emergency transports in claims submitted to Medicare and Medicaid; upcoded non-emergency ambulance transports from the hospital to patients’ residences, nursing homes, skilled nursing facilities, hospital-based diagnostic clinic, or dialysis clinics as emergency transports; and, submitted claims to Medicare and Medicaid for medically unnecessary ambulance transports of patients from the hospital to patients’ residences, nursing homes, skilled nursing facilities, hospital-based diagnostic clinic, or dialysis clinics.
Reportedly, Navicent Health underwent a 27-month investigation into its billing practices before the United States government decided to intervene.
“Since Navient 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.” stated Derrick L. Jackson, Special Agent in Charge of the Office of Inspector General of the U.S. Department of Health and Human Services.
The Whistleblower, a former Navicent paramedic, Andre Valentine, will receive a share of the settlement payment, as will the federal government and the state. Mr. Valentine, claimed in his 2015 lawsuit, that he was wrongfully terminated in 2014 after he questioned the hospital’s ambulance billing practices.
