Grant Memorial reports mistake, agrees to pay for false claims

Mineral Daily News-Tribune
Grant Memorial Hospital

CLARKSBURG – Grant Memorial Hospital in Petersburg has agreed to pay $320,175.71 for false medical claims after reporting the mistakes itself to state and federal officials.

U.S. Attorney Bill Powell announced Wednesday that Grant Memorial had filed false claims to Medicare, Medicaid, TRICARE, VA, and Railroad Retirement Programs from September 2014 to March 2016. The claims were for outpatient and inpatient services and items using the National Provider Identifier number and name of a credentialed physician, when, in fact, the services and items were actually provided by a non-credentialed physician.

“This case was the result of the hospital recognizing the mistake and bringing it to the attention of the federal government,” Powell said. “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,” he said.

West Virginia Attorney General Patrick Morrisey also praised the hospital for coming forward.

“Grant Memorial Hospital did the right thing by catching this fraud and reporting it,” he said. “Fighting fraud takes a team approach. We encourage anyone who suspects Medicaid fraud to report it. Such theft takes resources from those who need it most, and that underscores why our office remains dedicated to fighting fraud, waste and abuse.”

The hospital disclosed the claims in February 2019, pursuant to the Office of Inspector General of the Department of Health and Human Services self-disclosure protocol.

Grant Memorial’s self-report, coupled with an investigation by the Attorney General’s Medicaid Fraud Control Unit and U.S. Health and Human Services, contend Dr. Amanda Borror was not credentialed to provide certain services when she began employment at the Petersburg hospital in September 2014.

Investigators allege Dr. Borror provided services under the National Provider Identifier of another physician, and Grant Memorial named that physician as the rendering provider. Dr. Borror also used that physician’s login credentials to access electronic health records for outpatient services, an attempt to make it appear that he had provided services and signed notes that were actually completed by Dr. Borror.

The alleged conduct resulted in Medicaid paying Grant Memorial’s submission of false claims for outpatient and inpatient services that were improperly billed under that physician’s credentials.

Assistant U.S. Attorney Christopher J. Prezioso litigated the case on behalf of the government. Agencies involved in the investigation and settlement are the Office of Inspector General of the Department of Health and Human Services, the West Virginia Attorney General’s Office, the State of West Virginia Medicaid Fraud Control Unit, the West Virginia Bureau for Medical Services, the Defense Health Agency for TRICARE, and the U.S. Department of Veterans Affairs.

According to Morrisey, West Virginia will receive $302,108 from the settlement. The state will keep approximately $86,500, while the balance will reimburse federal Medicaid programs – a matter consistent with previous Medicaid settlements.

The West Virginia Bureau of Medicaid Services will receive approximately $57,724 of the state’s share.