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Editor: Mike Bothwell
Profession: Qui Tam Attorney

Category: Settlements and Verdicts

BlueCross BlueShield of Tennessee (BCBS-T) has settled with the United States in the amount of $2.1 million regarding allegations of violating the False Claims Act. BCBS-T is headquartered in Chattanooga, TN and operates as Riverbend Government Benefit Administrators.

The allegations involved BCBS-T, as the primary Medicare Part A Fiscal Intermediary for the state of New Jersey, not adjusting the cost-to-charge ratios in a timely manner for many hospitals located in New Jersey between 2000 and 2002. This has resulted in the payment of unnecessary "outlier payments" by the Medicare program for this facility.

U.S. Attorney for the District of New Jersey, Christopher J. Christie, said "The United States relies extensively upon trusted contractors to uphold the integrity of the Medicare system within New Jersey, and any abuse of that trust will be sharply addressed."

The settlement with BCBS-T resulted due to the coordinated effort among the Justice Department's Civil Division's Commercial Litigation Branch; the U.S. Attorney's Office for the District of New Jersey, Affirmative Civil Enforcement Unit; the Department of Health and Human Services, Office of Inspector General and Office of Counsel to the Inspector General; the Centers for Medicare and Medicaid Services; and the FBI.