MARYLAND TO RECEIVE $54,000 FOR IMPROPER
MEDICAID BILLING

Maryland Attorney General J. Joseph Curran Jr., announces that the Pediatrix Medical Group, Inc., a network of affiliated physician groups which provides medical services in various hospitals neonatal intensive care units in 32 states and Puerto Rico, has agreed to pay the State of Maryland $54,000 to settle allegations under the federal False Claims Act that Pediatrix improperly billed Medicaid, TRICARE, and the Federal Employee Health Benefits Program for neonatal care provided by their doctors. The federal government and 30 other states including the District of Columbia will receive more than $25 million.

The settlement covers the time period from January 1996 through December 1999, and resolves allegations that Pediatrix improperly applied CPT billing codes to neonatal services that did not accurately correspond to the medical condition of the infant or the services provided. Specifically, Pediatrix admitted infants to hospitals neonatal intensive care units using a CPT code for admission of critically ill infants, when a significant number of those infants were not in fact critically ill. Pediatrix used critical/unstable and critical/stable CPT codes for subsequent days of treatment, when a significant number of those infants were not in fact critically ill. Pediatrix also used critical/unstable and critical/stable CPT codes on discharge days, when many infants were not in fact critically ill.

In addition to the $25 Million payment, Pediatrix has reached an agreement with the Department of Health and Human Services' Office of Inspector General that the company's conduct will be monitored by the government under a Corporate Integrity Agreement. The company cooperated fully during the investigation.

The investigation was conducted jointly with the U.S. Attorney's Offices for the District of Colorado and the District of Maryland and a team from the National Association of Medicaid Fraud Control Units, of which the Maryland Attorney General’s Office is a member.