Memphis, TN – Decatur Hospital Authority, d/b/a Wise Health System in Decatur, Texas will pay $431,182.96 to the United States to resolve allegations of billing false claims to Medicare for genetic testing panels for surgical patients that were not medically reasonable or necessary.
The allegations were that from 2016 to 2018, Decatur Hospital Authority submitted samples from surgical patients to Tennessee based Total Diagnostic II, LLC labs for genetic testing that were not medically reasonable or necessary. This testing caused claims to be filed with Medicare that were false. Under federal law, Medicare will not pay for services that are not medically reasonable or necessary.
The False Claims Act, 31 U.S.C. §§ 3729-3733, provides the United States with a cause of action against any person or entity that knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval.
“Protecting the health and safety of Medicare patients is one of our primary concerns. When medical providers break the law by defrauding the government by providing medically unreasonable or unnecessary services we will use our resources to combat this fraud and hold them accountable,” said D. Michael Dunavant, United States Attorney for the Western District of Tennessee.
This investigation was conducted by the United States Department of Health and Human Services Office of the Inspector General and the United States Attorney’s Office for the Western District of Tennessee.
Assistant United States Attorneys Stuart J. Canale and Matt Waldrop prosecuted this case on behalf of the government.