In mid-February 2022, American Health Associates, Inc. (AHA) reached an agreement with the United States Department of Justice (DOJ) to resolve claims that the company knowingly caused the submission of false claims to Medicare. In the settlement, AHA agreed to pay $142,718.
According to the DOJ, from January 2015 through December 2019, AHA knowingly caused the submission of false claims to Medicare for diagnostic laboratory tests that were performed during patients’ inpatient stays at Access Hospital Dayton and already covered by the inpatient admission. Under Medicare rules and regulations, it will not make a separate payment for diagnostic testing performed during an inpatient admission.
AHA has offices in Cincinnati, Ohio, and acquired MedLab in 2014. MedLab is the company that provided laboratory services to Access Hospital Dayton.
Access Hospital Dayton
This settlement follows a settlement with Access Hospital Dayton, bringing the total recovery in this matter to $517,498. Under the False Claims Act, the United States can recover as much as three times the amount of damages sustained by the United States and these settlements were consistent with that multiplier.
Under the Access Dayton settlement, the government alleged that Access Dayton and its owner, Dr. John Johnson, knowingly caused the submission of false claims to Medicare and Ohio Medicaid for diagnostic laboratory testing on inpatient patients that was: (1) performed during their inpatient stay, (2) not used to manage the patient’s condition, and (3) not medically necessary.
The two types of laboratory testing were prolactin and ammonia testing. Prolactin testing is used to diagnose pituitary tumors or determine causes for conditions unrelated to psychosis or substance abuse. Ammonia testing is used to diagnose liver dysfunctions or hyperammonemia.
Access Dayton and Johnson also paid the State of Ohio $50,219 to resolve the Ohio Medicaid claims.