Bhc sierra vista hospital corporate integrity agreement

Attorney stated. The hospital also failed to obtain approval of certain outpatient treatment, document therapy sessions, obtain physician orders for lab work and obtain physician certifications for certain admissions. A man, charged for the second time with TennCare fraud, allegedly obtained Morphine Sulphate through a prescription then sold it to an undercover police officer. Another woman was charged with fraudulently obtaining TennCare benefits then selling portions of Hydrocodone and Oxycodone prescriptions.

The purpose of this complex review is to identify claims that have been reviewed validating medical necessity in short stay, uncomplicated admissions. This review will identify whether medical necessity was met per Medicare guidelines. Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals.

To comment on this article please go to editor racmonitor. Log In Create Account Menu. No products in the cart. May 4, Share This Article. It is intended for patients who have an acute mental illness. Regulations require outpatient hospitals to provide at least three defined services each day for payment under this program.

This requirement is meant to assure consistency in the level of program intensity among providers. Other alleged conduct resolved by this settlement agreement includes billing for outpatient treatment where beneficiaries attended only sporadically. There was also a failure to meet conditions required for payment, including: obtaining approval of certain outpatient treatment, documenting individual outpatient therapy sessions, obtaining physician orders for certain lab work and obtaining physician certification for certain admissions.

This settlement also resolves allegations contained in a whistleblower lawsuit filed by a former Sierra Vista Utilization Review Coordinator under the qui tam provisions of the False Claims Act. The whistleblower provisions of the False Claims Act permit private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery. Attorney Wagner. This settlement is the result of an investigation by the U.