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Navicent Pays $2.5 Million to Settle Allegations of False Claims Act Violations and Medicare and Medicaid Fraud

On August 3, 2017, the United States Attorney for the Middle District of Georgia and the Georgia Attorney General announced Navicent Health’s $2.5 million settlement to resolve allegations of violating the False Claims Act and billing Medicare and Medicaid for ambulance trips that were overpriced or not medically necessary.

Navicent Health, Inc. owns and operates the second largest hospital in Georgia named Medical Center, Navicent Health. Navicent, the corporation, operates in Georgia and oversees the Medical Center, including its emergency medical services, and is a participating provider of Medicare and Medicaid services. Whistleblower Andre Valentine, a former Navicent paramedic, filed a lawsuit against the corporation alleging improper billing practices that included overcharging patients for ambulance rides then billing those services to Medicaid and Medicare for reimbursement. Navicent underwent a 27-month investigation into its billing practices before the United States government decided to intervene, after which both parties agreed to settle the case with Navicent admitting no liability.

Derrick L. Jackson, Special Agent in Charge of the Office of Inspector General of the U.S. Department of Health and Human Services noted, “Since Navient owned and operated both the hospital and ambulances, profits from the systemic, deceptive practice of falsifying ‘emergency’ trips would fatten the hospital’s bottom line.”

Specifically, the agreed upon settlement resolved allegations of two of these deceptive billing schemes. First, Navicent allegedly billed non-emergency ambulance trips between hospitals as emergency ones, thus receiving inflated reimbursements. Second, Navicent allegedly billed ambulance trips of patients released from hospitals and care facilities to their private residences as emergency trips, again thus receiving inflated reimbursements from government medical programs. Many of these ambulance trips were neither necessary nor medical emergencies.

Georgia Attorney General added, “We appreciate the opportunity to work with our federal law enforcement partners to protect Georgia taxpayers and pursue those who attempt to inflate the costs of the Medicaid services they are trusted to facilitate.”

As a whistleblower protected under the False Claims Act, Mr. Valentine is entitled to receive between 15 and 25 percent of the $2.5 million recovered by his successful lawsuit.

© 2018 by Tycko & Zavareei LLP


About this Author

Jonathan K. Tycko leads the Whistleblower Practice Group of Tycko & Zavareei LLP

In recent years, the laws of the United States have undergone a whistleblower revolution. Federal and state governments now offer substantial monetary awards to individuals who come forward with information about fraud on government programs, tax fraud, securities fraud, and fraud involving the banking industry. Whistleblowers also now have important legal protections, designed to prevent retaliation and blacklisting.

The law firm of Tycko & Zavareei LLP works on the cutting edge of this whistleblower revolution, taking on even the most complex and confidential whistleblower...