Attorney General Chris Carr Announces Medicaid Fraud Settlement With United States Attorney for the Middle Disctrict of Georgia

ATLANTA, Aug. 4 -- Georgia Attorney General Chris Carr issued the following news release:

Attorney General Chris Carr and United States Attorney for the Middle District of Georgia G.F. "Pete" Peterman, III recently announced a civil settlement with The Medical Center of Central Georgia, Inc., more commonly known as The Medical Center, Navicent Health (Navicent).

"Enforcement of the Georgia False Medicaid Claims Act is a top priority for our office," said Georgia Attorney General Chris Carr. "We appreciate the opportunity to work with our federal law enforcement partners to protect Georgia taxpayers and pursue those who attempt to inflate the costs of the Medicaid services they are trusted to facilitate."

Navicent agreed to pay to the United States and the State of Georgia $2,549,742 to 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 organization, 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, revealing 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 concerns 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. The OIG's identification was based on data analytics conducted by the OIG's Office of Management and Policy, Consolidated Data Analysis Center.

As a result of this investigation, on May 8, 2017, the United States and the State of Georgia chose to intervene in Mr. Valentine's complaint and litigate the case in United States District Court. Today's settlement resolves the pending litigation. Navicent fully cooperated in the investigation, after which the parties agreed to resolve the allegations described herein. The claims covered by the settlement are allegations only, and there has been no determination of liability.

"Ambulance billing has long been an area of potential fraud on the Medicare and Medicaid programs and 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," said U.S Attorney G.F. "Pete" Peterman. "This case shows the value added when investigating health care fraud in a coordinated manner. By combining two parallel investigations, the Government was able to to achieve a valuable recovery on behalf of the taxpayers in the most efficient manner possible."

"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," said Derrick L. Jackson, Special Agent in Charge of the Office of Inspector General of the U.S. Department of Health and Human Services. "With the power of sophisticated data analytics to augment traditional investigative work, bringing health organizations to justice is surer than ever."

The case was investigated by the Department of Health & Human Services, Office of Inspector General, Investigators Enedelia Bostrup and Shaketia Morgan of the United States Attorney's Office for the Middle District of Georgia, and Investigator Trenton Williams and Chief Investigative Auditor Anita Reddick of the Georgia Medicaid Fraud Control Unit, a division of the Georgia Attorney General's Office. The United States' civil settlement was reached by Assistant United States Attorneys Todd P. Swanson and Aimee J. Hall. The State of Georgia's civil settlement was reached by Assistant Attorney General Elizabeth White.