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Hospitals, Medicare, and Medicaid Providers: Make Sure Your Billing Practices Don’t Violate The False Claims Act

above-the-bar-logo-no12.jpgThe New Milford Hospital, which is a part of the Western Connecticut Health Network, settled allegations this week with the government that it had violated the federal False Claims Act by over billing Medicare. The Hospital has agreed to pay $471,933 to settle the charges.

The government’s allegations relate to Medicare billing for the drug Lupron or Lupron Depot which is an injectible medication used to treat prostate cancer in men as well as endometriosis and fibroids in women. However, different doses are used to treat male and female patients and the billing code for treating women has a higher reimbursement rate than that for men. While conducting an internal audit, the government discovered that the hospital regularly submitted charges for the male patients as if they were for females. The government’s news release stated that in effect, the hospital received “substantially higher reimbursement from Medicare than it should have received,” in violation of the False Claims Act. Although the Hospital discovered that it was using the wrong billing code and conducted and internal audit to figure out how much it was overpaid, it did not report the error or make any attempts to return the money.

The False Claims Act, as amended by Congress in 2009 and 2010, provides that health care providers who learn that Medicare has overpaid them must notify officials and return any overpayments within 60 days or be subject to liability. Although New Milford did not pay triple damages here, the government can recover triple damages and civil penalties. If you have know of any physicians or hospitals engaged in Medicaid, Medicare, or any type of billing fraud against the government, or attorneys can help you bring a qui tam whistleblower lawsuit to expose the fraud and provide you with a monetary reward.

Spending on healthcare is a huge government expense in this country. Millions of Americans rely on state or federal funds for health insurance coverage. In fact, Medicare and Medicaid are the largest government sponsored healthcare plans and provide coverage for over 95 million Americans. In addition, other government plans also provide coverage for millions of federal and state government employees. Since these plans are funded with taxpayer monies, healthcare fraud in violation of the False Claims Act costs the government and taxpayers millions every year.

Given the voluminous number of healthcare claims submitted by American across the country, the government can not possible detect every instance of fraud. The qui tam whistleblower statute is a great tool that any individual with knowledge of fraud can use to help the government detect and expose healthcare fraud. Under the qui tam provisions of the False Claims Act, you can bring an action on behalf of the government if you have evidence of fraud being committed against the government. Depending on whether the government takes over you lawsuit or not, you may be entitled to recover anywhere from 15% to 30% of the government’s recovery.

Fraud in the healthcare industry is a national problem occurring in many hospitals and private practices throughout the country. In fact, two other Connecticut hospitals also settled similar cases. If you have knowledge or evidence of healthcare fraud being committed against the government, call our Whistleblower Attorneys at Villanueva & Sanchala at (800) 893-9645 to help you figure out how to proceed.


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New Milford Hospital Pays $471,933 for False Reporting, Danbury Patch

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