SETTLEMENT AGREEMENT - I.PARTIES - II.PREAMBLE - II.TERMS AND CONDITIONS

Sep 16, 2026

Settlement Agreement between the United States Department of Justice, acting through the Office of Inspector General (OIG-HHS), and University Medical Center of Southern Nevada (UMC). It addresses alleged Medicare inpatient claim conduct involving principal diagnosis code 482.89 during 1992-1997, including civil claims under the False Claims Act and administrative claims for permissive exclusion and civil monetary penalties. UMC agrees to pay a defined settlement amount, make related electronic funds transfer, cooperate with investigations, implement integrity provisions, and provide releases subject to stated conditions.

LanguageEnglish

CategoryLetters

FormatPDF

Pages38

Reading Time13 min

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SETTLEMENT AGREEMENT

I.PARTIES

II.PREAMBLE

II.TERMS AND CONDITIONS

1. Payment and offsets

2. Cooperation obligations

3. Integrity Provisions

4. Releases

# SETTLEMENT AGREEMENT ## I.PARTIES This Settlement Agreement(“Agreement”)is entered into between the United States offAmerica(“United States”),acting through the United States Department of Justice and on behalfof the Office of Inspector General("OIG-HHS")of the Department of Health and HumanServices("HHS");and University Medical Center of Southern Nevada("UMC")(hereafterreferred to as "the Parties"),through their authorized representatives. Ⅱ.PREAMBLE As a preamble to this Agreement,the Parties agree to the following: A. UMC provides inpatient and outpatient health care services to Medicarebeneficiaries and others. B. In connection with such services,UMC has submitted or caused to be submittedclaims for payment to the Medicare Program("Medicare"),Title XVⅢ of the Social SecurityAct,42 U.S.C.§§1395-1395ggg. C. Medicare payments to a hospital for inpatient treatment rendered to a beneficiarygenerally are based upon the beneficiary's "principal diagnosis”,as set forth by the hospital. D.The Medicare program relies upon participating hospitals to properly indicate theprincipal diagnosis through the use of standard diagnosis codes. E. The United States conducted an investigation into inpatient payment claimssubmitted to Medicare by hospitals with the principal diagnosis code of 482.89(pneumonia dueto “other specified bacteria”). F. The United States contends that it has certain civil claims against UMC under theFalse Claims Act,31 U.S.C.§§3729-3733,and other federal statutes and/or common lawdoctrines for engaging in the following alleged conduct during the period from October 1,1992through September 30,1997 in that UMC submitted or caused to be submitted claims to Medicarewith the principal diagnosis codes of 482.89 that were not supported by the correspondingmedical records(hereinafter referred to as the "Covered Conduct").The United States allegesthat,as a result of these claims,UMC received payments to which it was not entitled. G. The United States also contends that it has certain administrative claims against UMC under the provisions for permissive exclusion from Medicare,Medicaid and other federalhealth care programs,42 U.S.C.§1320a-7(b),and the provisions for civil monetary penalties,42U.S.C.§1320a-7a,and the Program Fraud Civil Remedies Act,31 U.S.C.§§3801-3812,for theCovered Conduct. H. UMC has provided documents and information to the United States in response tothe government's investigation of the Covered Conduct,including patient files for which claimswere submitted to the Medicare Programs with the principal diagnosis code of 482.89,and UMCrepresents that such response has been truthful,accurate,and complete to the best of its currentknowledge and belief. I.UMC denies the contentions of the United States as set forth in paragraphs F andG above and as forth in the action captioned United States ex rel.Health Outcomes Technologiesv.University Medical Center.Civil Action No.CV-S-01-538-RLH(RJJ)(UNDER SEAL),inthe United States District Court for the District of Nevada. J.To avoid the delay,uncertainty,inconvenience and expense of protractedlitigation of these claims,the Parties reach a full and final settlement as set forth below. ## II.TERMS AND CONDITIONS NOW,THEREFORE,in consideration of the mutual promises,covenants,andobligations set forth below,and for good and valuable consideration as stated herein,the Partiesagree as follows: 1.UMC agrees to pay to the United States the sum of $1,163,488(the "SettlementAmount"),as follows:UMC agrees to make payment of the Settlement Amount less an offset of$438,488-which offset results from a repayment of $438,488 made by UMC to the UnitedStates on or about January 29,1999-by electronic funds transfer pursuant to written instructionsprovided by Michael F.Hertz,Director,Commercial Litigation Branch.UMC agrees to makethis electronic funds transfer in the amount of $725,000 no later than five(5)business days afterthe effective date

FAQs

What parties are involved in the settlement agreement?

The agreement is entered between the United States Department of Justice, acting through OIG-HHS, and University Medical Center of Southern Nevada (UMC), through their authorized representatives.

What alleged Medicare-related conduct does the agreement address?

It concerns claims submitted to Medicare using principal diagnosis code 482.89 (pneumonia due to other specified bacteria) that the United States contends were not supported by corresponding medical records during the period from October 1, 1992 through September 30, 1997.

How does UMC satisfy its payment obligation under the agreement?

UMC agrees to pay the settlement amount subject to an offset from a prior repayment, and to complete an electronic funds transfer of the remaining amount no later than five business days after the agreement’s effective date.

Sep 16, 2026

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