On June 24, 2020, the United States Attorney for the Southern District of Georgia announced that Augusta University Medical Center, Inc. (AUMC) has agreed to pay $2.625 million to the United States to settle allegations that AUMC violated the False Claims Act by knowingly submitting claims to federal healthcare programs for a procedure that was not covered by Medicare and Medicaid.

The government’s investigation involved medically unreasonable and unnecessary procedures, that AUMC referred to as a “Belsey Collis.”  There is actually no such medical procedure.  However, AUMC billed “Belsey Collis” procedures as well as post-surgical follow-up care as though the procedure was covered by Medicare and Medicaid.

Commenting on the case, Chris Hacker, Special Agent in Charge of FBI Atlanta said “It is vitally important that we protect our government funded health care programs against fraud of any kind. This case is an example of the cooperative investigative efforts of federal and state partners to make sure monies from these important programs are directed only to legitimate claims.”

The investigation into AUMC was launched by federal investigators and investigators from the State of Georgia and the State of South Carolina.  However, under the qui tam provisions of the False Claims Act, private whistleblowers with information about similar fraud against the government may bring a civil case on behalf of the United States. If successful, the government can recover three times the amount the defendants fraudulently billed the government.  The whistleblower, who originally filed the case, is entitled to 15-30% of the government’s recovery as well as their attorney’s fees.

If you have questions about medical billing fraud or the False Claims Act, contact Frohsin Barger & Walthall.

Read the full Department of Justice Press Release here