Department of Justice

No Medicare fraud suspected; coding changes cited for errors

Jefferson Medical Associates, a now dissolved, multi-specialty medical practice group in Laurel, and Dr. Aremmia Tanious have agreed to pay the United States $817,635.06 to resolve claims under the False Claims Act arising from Medicare overpayments to Jefferson Medical Associates and Dr. Tanious, U.S. Attorney Mike Hurst said.

The claims resolved by this settlement are allegations only, and there has been no determination of civil liability, Hurst said.

“Over the years, coding and billing health care claims has gotten very complicated,” Tanious said. “For that reason, we did regular internal audits at the clinic to ensure everything was correct. During that internal audit by the clinic, Jefferson Medical Associates found coding errors that resulted in overpayments and reported the overpayment to CMS (the Center’s for Medicare and Medicaid). 

“Jefferson Medical Associates also hired a former Assistant U.S. Attorney with years of experience in health care matters to investigate. Jefferson Medical Associates also voluntarily participated in a CMS audit and fully cooperated by providing information. The outcome was, no fraud was committed, however, a repayment of funds with penalties was required.”

This settlement resolves allegations that from Jan. 1, 2012, through December 31, 2014, Jefferson Medical Associates and Tanious violated the False Claims Act by failing to return overpayments they received from Medicare on claims. In addition, from Feb. 1, 2013, through June 30, 2017, it was alleged that Jefferson Medical Associates and Tanious billed Medicare using multiple medical codes when the medical documentation did not support the use of such billing practices.

During the course of the government’s investigation, Jefferson Medical Associates and Tanious provided assistance through voluntary disclosures to the U.S. Attorney’s Office after they discovered through audits of patient files and claims data that Medicare had been overbilled for certain services.

“This settlement should serve as a reminder to medical providers receiving Medicare funds that they must timely report and return any overpayments owed to Medicare or be subject to liability under the False Claims Act. I applaud our healthcare fraud investigators and prosecutors, as well as agents with the Office of Inspector General for Health and Human Services, for their diligent work in recovering the public’s money,” Hurst said.

This matter was investigated by the U.S. Attorney’s Office Healthcare Fraud Investigator Ron Jefferson and U.S. Department of Health and Human Services Office of Inspector General. 

In 2017, South Central Regional Medical Center acquired Jefferson Medical.

“Many physicians who previously worked in private practice in Jones County have come to us over the years and asked that we acquire their practice,” Doug Higginbotham, president and chief executive officer of South Central Regional Medical Center, said at the time. “Since we have done so, they have seemed to be pleased with the transition. They enjoy focusing their time on patient care.”

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