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Hospital in West Virginia to Pay More Than $320,000 for Fraudulent Claims

A West Virginia hospital recently agreed to pay more than $320,000 in restitution for filing fraudulent medical claims.

Bill Powell, a U.S. Attorney, announced the agreement with Grant Memorial Hospital, which is located in Petersburg, West Virginia.

The settle agreement revolves around false claims the hospital filed with five health-care programs — TRICARE, the Veterans Administration, Medicaid, Medicare and Railroad Retirement Programs. All the claims were filed between September 2014 and March 2016.

The hospital billed the claims for both inpatient and outpatient services, as well as various medical items. When filing the claims, Grant Memorial Hospital used a credentialed physicians name as well as a National Provider Identification number.

The fraud applies because the items and services that were billed for were in reality conducted by a physician who wasn’t credentialed.

As Powell said:

“This case was the result of the hospital recognizing the mistake and bringing it to the attention of the federal government. I commend the hospital management for ensuring that this wrong was righted. All medical providers should take note, and when a mistake in billing is made report the issue immediately.” In February 2019, officials from the hospital reported the fraudulent claims. The officials correctly followed the protocol for self-disclosure that’s set forth by the OIG (Office of Inspector General of the DHHS (Department of Health and Human Services).

The case was litigated by Christopher J. Prezioso, an assistant U.S. Attorney. There were six state and federal agencies that participated in both the settlement and investigation into the incident.