S.C. Management to Pay U.S. to Resolve Civil Claims of Improper Medicaire Billings

SC Management Inc., has reportedly agreed to pay the United States $167,228 to resolve civil claims relating to false Medicare billings for services provided at Missouri’s Twin Rivers Regional Medical Center from Jan. 1, 1993, to Dec. 31, 1996, United States Attorney James Martin announced recently. Twin Rivers was formerly a part of the Tenet Health System chain of hospitals. Tenet sold Twin Rivers in November 2003.

The settlement resolves allegations that Twin Rivers submitted false claims for inpatient payment claims to Medicare with the principal diagnosis code of 482.89 (pneumonia due to “other specified bacteria”) that were not supported by the corresponding medical records. The Medicare program relies upon participating hospitals to properly indicate the principal diagnosis through the use of standard diagnosis codes.

As the result of the improper billings, Twin Rivers reportedly received payments to which it was not entitled.