The National Association of Medicaid Fraud Control Units (NAMFCU) announced that Pediatrix Medical Group, Inc., a network of affiliated physician groups which provides medical services in various hospital neonatal intensive care units in 32 states and Puerto Rico, has agreed to pay the United States and 30 states and the District of Columbia $25,078,918 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 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 hospital 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.

The company cooperated fully during the investigation.

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.